The Zywiec Act: End Child Mutilation

Language for every single US State

Hello all. This year I wrote a bill and was able to introduce legislation into the State of Minnesota to criminalize the pharmacological castration and surgical mutilation of children, also known as “gender affirming care.” The language uses existing state law to avoid ex post facto violations and would ensure that every healthcare provider who has been involved in such care can be both held civilly liable and be criminally charged and held

Photo by Alexander Grey on Unsplash

to account. Below is the language for EVERY SINGLE STATE. All you have to do is send this language to one of your Republican representatives and ask that they introduce this bill. I implore you, get involved. This is the most egregious crime in the history of medicine, and it must end. Some states are “safe havens,” and have protective laws. This would require more work, however, the templates I have written below are the best places to start. God bless.

Alabama

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Alabama prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Legislature of the State of Alabama:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 19 years (Code of Ala. § 15-20A-4).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Alabama (Code of Ala. § 34-24-50).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Alabama.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Alabama healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (Code of Ala. § 22-6-13).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Alabama may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (Code of Ala. § 6-5-484): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (Code of Ala. § 13A-6-25): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (Code of Ala. § 13A-10-2): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (Code of Ala. § 13A-6-20 - 13A-6-22): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., Code of Ala. § 15-3-5 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 19 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Alabama Board of Medical Examiners or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (Code of Ala. § 13A-5-6).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 7 years imprisonment and/or a $15,000 fine (Code of Ala. § 13A-5-6).

(2) Coercion: Up to 7 years imprisonment and/or a $15,000 fine (Code of Ala. § 13A-6-25).

(3) Misconduct: Up to 1 year imprisonment and/or a $6,000 fine (Code of Ala. § 13A-10-2).

(4) Assault/Battery: Varies by degree, up to 20 years and/or $30,000 for severe cases (Code of Ala. § 13A-6-20).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Alabama Department of Public Health shall investigate alleged prospective violations of Section 3, and the Alabama Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Alabama Department of Public Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Alabama’s SB 184 (2022) bans gender-affirming care for minors, with felony penalties up to 10 years. This bill aligns but introduces retrospective prosecution and higher fines, which may conflict with ex post facto protections and statute of limitations (Code of Ala. § 15-3-5).

Alaska

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Alaska prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Alaska State Legislature:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (AS 25.20.010).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Alaska (AS 08.64).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Alaska.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Alaska healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (AS 47.07.030).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Alaska may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (AS 11.51.100): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (AS 11.61.120): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (AS 11.56.850): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (AS 11.41.200 - 11.41.230): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., AS 12.10.010 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Alaska Medical Board or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (AS 11.81.900).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 7 years imprisonment and/or a $50,000 fine (AS 11.51.100).

(2) Coercion: Up to 5 years imprisonment and/or a $50,000 fine (AS 11.61.120).

(3) Misconduct: Up to 1 year imprisonment and/or a $10,000 fine (AS 11.56.850).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $50,000 for severe cases (AS 11.41.200).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Alaska Department of Health shall investigate alleged prospective violations of Section 3, and the Alaska Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Alaska Department of Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Alaska has no ban on gender-affirming care, and this bill would represent a major policy shift. Retrospective prosecution may be limited by Alaska’s strict statute of limitations (AS 12.10.010), and the bill may face opposition in a state with moderate views on healthcare.

Arizona

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Arizona prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Arizona State Legislature:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (A.R.S. § 1-215).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Arizona (A.R.S. § 32-1401).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Arizona.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Arizona healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (A.R.S. § 36-2907).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Arizona may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (A.R.S. § 13-1103): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (A.R.S. § 13-1202): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (A.R.S. § 13-2407): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (A.R.S. § 13-1203 - 13-1204): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., A.R.S. § 13-107 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Arizona Medical Board or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (A.R.S. § 13-801).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 7 years imprisonment and/or a $15,000 fine (A.R.S. § 13-1103).

(2) Coercion: Up to 7 years imprisonment and/or a $15,000 fine (A.R.S. § 13-1202).

(3) Misconduct: Up to 6 months imprisonment and/or a $2,500 fine (A.R.S. § 13-2407).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $15,000 for severe cases (A.R.S. § 13-1204).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Arizona Department of Health Services shall investigate alleged prospective violations of Section 3, and the Arizona Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Arizona Department of Health Services or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Arizona’s SB 1138 (2022) bans gender-affirming surgeries for minors but allows hormone therapy. This bill expands the ban to all gender-affirming care, aligning with Arizona’s conservative policies but potentially facing challenges in liberal jurisdictions or under federal law.

Arkansas

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Arkansas prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Arkansas General Assembly:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (Ark. Code § 9-25-101).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Arkansas (Ark. Code § 17-95-201).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Arkansas.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Arkansas healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (Ark. Code § 20-77-101).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Arkansas may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (Ark. Code § 5-27-205): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (Ark. Code § 5-53-113): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (Ark. Code § 5-52-107): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (Ark. Code § 5-13-201 - 5-13-204): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., Ark. Code § 5-1-109 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Arkansas State Medical Board or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (Ark. Code § 5-4-401).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 6 years imprisonment and/or a $10,000 fine (Ark. Code § 5-27-205).

(2) Coercion: Up to 7 years imprisonment and/or a $15,000 fine (Ark. Code § 5-53-113).

(3) Misconduct: Up to 1 year imprisonment and/or a $2,500 fine (Ark. Code § 5-52-107).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $15,000 for severe cases (Ark. Code § 5-13-201).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Arkansas Department of Health shall investigate alleged prospective violations of Section 3, and the Arkansas Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Arkansas Department of Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Arkansas’s HB 1570 (2021), the SAFE Act, bans gender-affirming care for minors but is currently enjoined by federal courts. This bill strengthens the ban with retrospective prosecution, which may face legal challenges if the injunction persists or due to ex post facto concerns.

California

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of California prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the California State Legislature:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (Cal. Fam. Code § 6500).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of California (Cal. Bus. & Prof. Code § 500).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of California.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other California healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (Cal. Welf. & Inst. Code § 14000).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of California may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (Cal. Penal Code § 273a): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (Cal. Penal Code § 136.1): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (Cal. Penal Code § 424): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (Cal. Penal Code § 242 - 243): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., Cal. Penal Code § 801 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Medical Board of California or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (Cal. Penal Code § 1170).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 7 years imprisonment and/or a $15,000 fine (Cal. Penal Code § 273a).

(2) Coercion: Up to 3 years imprisonment and/or a $10,000 fine (Cal. Penal Code § 136.1).

(3) Misconduct: Up to 7 years imprisonment and/or a $15,000 fine (Cal. Penal Code § 424).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $15,000 for severe cases (Cal. Penal Code § 243).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The California Department of Public Health shall investigate alleged prospective violations of Section 3, and the California Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the California Department of Public Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: California’s SB 107 (2022) establishes the state as a sanctuary for gender-affirming care, protecting providers and families from out-of-state bans. This bill directly conflicts with current law and would face significant legal and political opposition in a state with strong protections for transgender healthcare.

Colorado

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Colorado prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Colorado General Assembly:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (C.R.S. § 13-22-101).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Colorado (C.R.S. § 12-240-101).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Colorado.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Colorado healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (C.R.S. § 25.5-4-401).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Colorado may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (C.R.S. § 18-6-401): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (C.R.S. § 18-5-302): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (C.R.S. § 18-8-404): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (C.R.S. § 18-3-202 - 18-3-204): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., C.R.S. § 16-5-401 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Colorado Medical Board or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (C.R.S. § 18-1.3-401).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 7 years imprisonment and/or a $100,000 fine (C.R.S. § 18-6-401).

(2) Coercion: Up to 7 years imprisonment and/or a $100,000 fine (C.R.S. § 18-5-302).

(3) Misconduct: Up to 18 months imprisonment and/or a $5,000 fine (C.R.S. § 18-8-404).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $100,000 for severe cases (C.R.S. § 18-3-202).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Colorado Department of Public Health and Environment shall investigate alleged prospective violations of Section 3, and the Colorado Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Colorado Department of Public Health and Environment or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Colorado’s HB 23-1077 (2023) designates the state as a safe haven for gender-affirming care, protecting providers and patients. This bill directly contradicts current law and would face significant legal and political opposition in a state with strong transgender healthcare protections.

Connecticut

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Connecticut prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Connecticut General Assembly:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (Conn. Gen. Stat. § 1-1d).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Connecticut (Conn. Gen. Stat. § 20-10).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Connecticut.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Connecticut healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (Conn. Gen. Stat. § 17b-260).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Connecticut may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (Conn. Gen. Stat. § 53a-196): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (Conn. Gen. Stat. § 53a-182b): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (Conn. Gen. Stat. § 53a-165): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (Conn. Gen. Stat. § 53a-71 - 53a-73): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., Conn. Gen. Stat. § 54-193 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Connecticut Medical Examining Board or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (Conn. Gen. Stat. § 53a-35a).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 7 years imprisonment and/or a $15,000 fine (Conn. Gen. Stat. § 53a-196).

(2) Coercion: Up to 1 year imprisonment and/or a $2,000 fine (Conn. Gen. Stat. § 53a-182b).

(3) Misconduct: Up to 5 years imprisonment and/or a $5,000 fine (Conn. Gen. Stat. § 53a-165).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $15,000 for severe cases (Conn. Gen. Stat. § 53a-71).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Connecticut Department of Public Health shall investigate alleged prospective violations of Section 3, and the Connecticut Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Connecticut Department of Public Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Connecticut’s HB 7008 (2022) establishes the state as a sanctuary for gender-affirming care, protecting providers from out-of-state bans. This bill directly contradicts current law and would face strong legal and political opposition in a state with robust transgender healthcare protections.

Delaware

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Delaware prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Delaware General Assembly:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (Del. Code Ann. tit. 1, § 302).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Delaware (Del. Code Ann. tit. 24, § 1702).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Delaware.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Delaware healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (Del. Code Ann. tit. 31, § 505).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Delaware may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (Del. Code Ann. tit. 11, § 1100): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (Del. Code Ann. tit. 11, § 1211): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (Del. Code Ann. tit. 11, § 1207): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (Del. Code Ann. tit. 11, § 611 - 613): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., Del. Code Ann. tit. 11, § 205 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Delaware Board of Medical Licensure and Discipline or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (Del. Code Ann. tit. 11, § 4205).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 7 years imprisonment and/or a $10,000 fine (Del. Code Ann. tit. 11, § 1100).

(2) Coercion: Up to 1 year imprisonment and/or a $2,300 fine (Del. Code Ann. tit. 11, § 1211).

(3) Misconduct: Up to 2 years imprisonment and/or a $5,500 fine (Del. Code Ann. tit. 11, § 1207).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $15,000 for severe cases (Del. Code Ann. tit. 11, § 613).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Delaware Division of Public Health shall investigate alleged prospective violations of Section 3, and the Delaware Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Delaware Division of Public Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Delaware’s SB 65 (2023) protects gender-affirming care, ensuring access for minors with parental consent. This bill reverses that policy and would face significant opposition in a state with progressive healthcare laws.

Florida

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Florida prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Florida Legislature:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (Fla. Stat. § 1.01).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Florida (Fla. Stat. § 456.001).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Florida.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Florida healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (Fla. Stat. § 409.905).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Florida may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (Fla. Stat. § 827.03): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (Fla. Stat. § 836.10): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (Fla. Stat. § 838.022): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (Fla. Stat. § 784.03 - 784.045): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., Fla. Stat. § 775.15 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Florida Board of Medicine or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (Fla. Stat. § 775.082).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 7 years imprisonment and/or a $15,000 fine (Fla. Stat. § 827.03).

(2) Coercion: Up to 5 years imprisonment and/or a $5,000 fine (Fla. Stat. § 836.10).

(3) Misconduct: Up to 5 years imprisonment and/or a $5,000 fine (Fla. Stat. § 838.022).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $15,000 for severe cases (Fla. Stat. § 784.045).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Florida Department of Health shall investigate alleged prospective violations of Section 3, and the Florida Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Florida Department of Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Florida’s SB 254 (2023) bans gender-affirming care for minors, with felony penalties for providers. This bill aligns but adds retrospective prosecution, which may face ex post facto challenges under Florida’s constitution (Fla. Const. Art. I, § 10).

Georgia

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Georgia prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Georgia General Assembly:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (O.C.G.A. § 39-1-1).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Georgia (O.C.G.A. § 43-34-1).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Georgia.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Georgia healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (O.C.G.A. § 49-4-141).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Georgia may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (O.C.G.A. § 16-5-70): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (O.C.G.A. § 16-10-32): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (O.C.G.A. § 16-10-1): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (O.C.G.A. § 16-5-20 - 16-5-23): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., O.C.G.A. § 17-3-1 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Georgia Composite Medical Board or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (O.C.G.A. § 16-1-7).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 7 years imprisonment and/or a $15,000 fine (O.C.G.A. § 16-5-70).

(2) Coercion: Up to 7 years imprisonment and/or a $15,000 fine (O.C.G.A. § 16-10-32).

(3) Misconduct: Up to 1 year imprisonment and/or a $1,000 fine (O.C.G.A. § 16-10-1).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $15,000 for severe cases (O.C.G.A. § 16-5-21).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Georgia Department of Public Health shall investigate alleged prospective violations of Section 3, and the Georgia Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Georgia Department of Public Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Georgia’s SB 140 (2023) bans hormone therapy and surgeries for minors, with exceptions for intersex conditions. This bill expands the ban and adds retrospective prosecution, aligning with Georgia’s conservative policies but potentially facing challenges under statute of limitations laws (O.C.G.A. § 17-3-1).

Hawaii

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Hawaii prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Hawaii State Legislature:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (HRS § 577-1).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Hawaii (HRS § 453-1).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Hawaii.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Hawaii healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (HRS § 346-14).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Hawaii may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (HRS § 709-906): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (HRS § 710-1000): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (HRS § 710-1000): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (HRS § 707-710 - 707-712): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., HRS § 701-108 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Hawaii Medical Board or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (HRS § 701-107).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 7 years imprisonment and/or a $15,000 fine (HRS § 709-906).

(2) Coercion: Up to 5 years imprisonment and/or a $10,000 fine (HRS § 710-1000).

(3) Misconduct: Up to 1 year imprisonment and/or a $2,000 fine (HRS § 710-1000).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $15,000 for severe cases (HRS § 707-710).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Hawaii Department of Health shall investigate alleged prospective violations of Section 3, and the Hawaii Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Hawaii Department of Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Hawaii’s SB 1 (2023) protects gender-affirming care, ensuring access for minors with parental consent. This bill reverses that policy and would face strong opposition in a state with robust LGBTQ+ protections.

Idaho

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Idaho prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Idaho Legislature:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (Idaho Code § 16-1602).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Idaho (Idaho Code § 54-1803).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Idaho.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Idaho healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (Idaho Code § 56-202).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Idaho may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (Idaho Code § 18-1506): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (Idaho Code § 18-6602): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (Idaho Code § 18-1356): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (Idaho Code § 18-901 - 18-905): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., Idaho Code § 19-401 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Idaho Board of Medicine or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (Idaho Code § 18-101A).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 7 years imprisonment and/or a $15,000 fine (Idaho Code § 18-1506).

(2) Coercion: Up to 2 years imprisonment and/or a $5,000 fine (Idaho Code § 18-6602).

(3) Misconduct: Up to 7 years imprisonment and/or a $15,000 fine (Idaho Code § 18-1356).

(4) Assault/Battery: Varies by degree, up to 5 years and/or $5,000 for severe cases (Idaho Code § 18-905).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Idaho Department of Health and Welfare shall investigate alleged prospective violations of Section 3, and the Idaho Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Idaho Department of Health and Welfare or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Idaho’s HB 71 (2023) bans gender-affirming care for minors, with felony penalties up to 7 years. This bill aligns but adds retrospective prosecution, potentially facing ex post facto challenges under Idaho’s constitution (Idaho Const. Art. I, § 16).

Illinois

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Illinois prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Illinois General Assembly:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (705 ILCS 405/1-3).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Illinois (225 ILCS 60/2).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Illinois.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Illinois healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (305 ILCS 5/5-1).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Illinois may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (720 ILCS 5/12-34): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (720 ILCS 5/33A-2): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (720 ILCS 5/33-3): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (720 ILCS 5/12-3 - 720 ILCS 5/12-4): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., 720 ILCS 5/3-5 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Illinois Department of Financial and Professional Regulation or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (720 ILCS 5/2-7).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 7 years imprisonment and/or a $25,000 fine (720 ILCS 5/12-34).

(2) Coercion: Up to 7 years imprisonment and/or a $25,000 fine (720 ILCS 5/33A-2).

(3) Misconduct: Up to 3 years imprisonment and/or a $25,000 fine (720 ILCS 5/33-3).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $25,000 for severe cases (720 ILCS 5/12-4).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Illinois Department of Public Health shall investigate alleged prospective violations of Section 3, and the Illinois Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Illinois Department of Public Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Illinois’s HB 2352 (2023) protects gender-affirming care, ensuring access for minors with parental consent. This bill reverses that policy and would face significant opposition in a state with strong protections for transgender healthcare.

Indiana

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Indiana prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Indiana General Assembly:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (Ind. Code § 1-1-4-5).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Indiana (Ind. Code § 25-22.5-1).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Indiana.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Indiana healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (Ind. Code § 12-15-1-1).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Indiana may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (Ind. Code § 35-46-1-4): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (Ind. Code § 35-45-4-2): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (Ind. Code § 35-44.1-1-1): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (Ind. Code § 35-42-2-1 - 35-42-2-1.5): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., Ind. Code § 35-41-4-2 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Indiana Medical Licensing Board or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (Ind. Code § 35-50-2-4).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 7 years imprisonment and/or a $10,000 fine (Ind. Code § 35-46-1-4).

(2) Coercion: Up to 3 years imprisonment and/or a $10,000 fine (Ind. Code § 35-45-4-2).

(3) Misconduct: Up to 1 year imprisonment and/or a $5,000 fine (Ind. Code § 35-44.1-1-1).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $10,000 for severe cases (Ind. Code § 35-42-2-1.5).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Indiana Department of Health shall investigate alleged prospective violations of Section 3, and the Indiana Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Indiana Department of Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Indiana’s SB 480 (2023) bans gender-affirming care for minors, with enforcement by the Attorney General. This bill aligns but adds retrospective prosecution, which may face legal scrutiny under Indiana’s statute of limitations (Ind. Code § 35-41-4-2).

Iowa

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Iowa prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Iowa General Assembly:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (Iowa Code § 599.1).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Iowa (Iowa Code § 148.1).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Iowa.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Iowa healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (Iowa Code § 249A.3).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Iowa may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (Iowa Code § 726.6): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (Iowa Code § 710.4): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (Iowa Code § 721.2): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (Iowa Code § 708.1 - 708.3): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., Iowa Code § 802.3 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Iowa Board of Medicine or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (Iowa Code § 902.9).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 7 years imprisonment and/or a $15,000 fine (Iowa Code § 726.6).

(2) Coercion: Up to 2 years imprisonment and/or a $6,250 fine (Iowa Code § 710.4).

(3) Misconduct: Up to 2 years imprisonment and/or a $6,250 fine (Iowa Code § 721.2).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $15,000 for severe cases (Iowa Code § 708.3).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Iowa Department of Public Health shall investigate alleged prospective violations of Section 3, and the Iowa Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Iowa Department of Public Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Iowa’s SF 538 (2023) bans gender-affirming care for minors, with penalties for providers. This bill aligns but adds retrospective prosecution, potentially complicating enforcement due to Iowa’s statute of limitations (Iowa Code § 802.3).

Kansas

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Kansas prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Kansas Legislature:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (K.S.A. § 38-101).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Kansas (K.S.A. § 65-2802).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Kansas.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Kansas healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (K.S.A. § 39-708c).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Kansas may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (K.S.A. § 21-6412): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (K.S.A. § 21-5601): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (K.S.A. § 21-6002): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (K.S.A. § 21-5413 - 21-5414): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., K.S.A. § 21-5107 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Kansas State Board of Healing Arts or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (K.S.A. § 21-6604).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 7 years imprisonment and/or a $15,000 fine (K.S.A. § 21-6412).

(2) Coercion: Up to 7 years imprisonment and/or a $15,000 fine (K.S.A. § 21-5601).

(3) Misconduct: Up to 1 year imprisonment and/or a $2,500 fine (K.S.A. § 21-6002).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $15,000 for severe cases (K.S.A. § 21-5413).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Kansas Department of Health and Environment shall investigate alleged prospective violations of Section 3, and the Kansas Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Kansas Department of Health and Environment or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Kansas’s SB 233 (2023) was vetoed, leaving no ban on gender-affirming care. This bill introduces a ban and retrospective prosecution, facing resistance in a state with mixed legislative views on transgender healthcare.

Kentucky

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Kentucky prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Kentucky General Assembly:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (KRS § 2.015).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Kentucky (KRS § 311.550).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Kentucky.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Kentucky healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (KRS § 205.510).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Kentucky may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (KRS § 508.100): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (KRS § 509.080): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (KRS § 522.020): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (KRS § 508.010 - 508.030): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., KRS § 500.050 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Kentucky Board of Medical Licensure or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (KRS § 532.060).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 7 years imprisonment and/or a $10,000 fine (KRS § 508.100).

(2) Coercion: Up to 5 years imprisonment and/or a $10,000 fine (KRS § 509.080).

(3) Misconduct: Up to 5 years imprisonment and/or a $10,000 fine (KRS § 522.020).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $10,000 for severe cases (KRS § 508.010).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Kentucky Cabinet for Health and Family Services shall investigate alleged prospective violations of Section 3, and the Kentucky Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Kentucky Cabinet for Health and Family Services or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Kentucky’s SB 150 (2023) bans gender-affirming care for minors, with enforcement mechanisms. This bill aligns but adds retrospective prosecution, potentially facing challenges under Kentucky’s statute of limitations (KRS § 500.050).

Louisiana

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Louisiana prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Louisiana Legislature:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (La. Civ. Code art. 29).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Louisiana (La. R.S. 37:1262).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Louisiana.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Louisiana healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (La. R.S. 46:437.3).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Louisiana may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (La. R.S. 14:93): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (La. R.S. 14:107.1): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (La. R.S. 14:134): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (La. R.S. 14:33 - 14:34): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., La. C.Cr.P. art. 571.1 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Louisiana State Board of Medical Examiners or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (La. R.S. 14:2).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 5 years imprisonment and/or a $5,000 fine (La. R.S. 14:93).

(2) Coercion: Up to 2 years imprisonment and/or a $2,000 fine (La. R.S. 14:107.1).

(3) Misconduct: Up to 2 years imprisonment and/or a $2,000 fine (La. R.S. 14:134).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $5,000 for severe cases (La. R.S. 14:34).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Louisiana Department of Health shall investigate alleged prospective violations of Section 3, and the Louisiana Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Louisiana Department of Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Louisiana’s HB 648 (2023) bans gender-affirming care for minors, with penalties for providers. This bill aligns but adds retrospective prosecution, potentially facing challenges under Louisiana’s prescription laws (La. C.Cr.P. art. 571.1).

Maine

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Maine prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Maine Legislature:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (22 M.R.S. § 4002).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Maine (32 M.R.S. § 3300-A).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Maine.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Maine healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (22 M.R.S. § 3173).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Maine may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (17-A M.R.S. § 553): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (17-A M.R.S. § 707): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (17-A M.R.S. § 604): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (17-A M.R.S. § 207 - 209): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., 17-A M.R.S. § 8 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Maine Board of Licensure in Medicine or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (17-A M.R.S. § 1604).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 7 years imprisonment and/or a $5,000 fine (17-A M.R.S. § 553).

(2) Coercion: Up to 1 year imprisonment and/or a $2,000 fine (17-A M.R.S. § 707).

(3) Misconduct: Up to 1 year imprisonment and/or a $2,000 fine (17-A M.R.S. § 604).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $5,000 for severe cases (17-A M.R.S. § 207).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Maine Department of Health and Human Services shall investigate alleged prospective violations of Section 3, and the Maine Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Maine Department of Health and Human Services or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Maine’s LD 1735 (2023) protects gender-affirming care, ensuring access for minors with parental consent. This bill reverses that policy and would face significant opposition in a state with strong LGBTQ+ protections.

Maryland

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Maryland prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Maryland General Assembly:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (Md. Code Ann., Gen. Prov. § 1-401).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Maryland (Md. Code Ann., Health Occ. § 1-101).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Maryland.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Maryland healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (Md. Code Ann., Health-Gen. § 15-101).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Maryland may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (Md. Code Ann., Crim. Law § 3-602): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (Md. Code Ann., Crim. Law § 3-707): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (Md. Code Ann., Crim. Law § 9-201): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (Md. Code Ann., Crim. Law § 3-202 - 3-203): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., Md. Code Ann., Cts. & Jud. Proc. § 5-106 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Maryland Board of Physicians or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (Md. Code Ann., Crim. Law § 7-104).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 5 years imprisonment and/or a $10,000 fine (Md. Code Ann., Crim. Law § 3-602).

(2) Coercion: Up to 7 years imprisonment and/or a $5,000 fine (Md. Code Ann., Crim. Law § 3-707).

(3) Misconduct: Up to 3 years imprisonment and/or a $5,000 fine (Md. Code Ann., Crim. Law § 9-201).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $5,000 for severe cases (Md. Code Ann., Crim. Law § 3-202).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Maryland Department of Health shall investigate alleged prospective violations of Section 3, and the Maryland Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Maryland Department of Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Maryland’s HB 91 (2023) protects gender-affirming care, ensuring access for minors with parental consent. This bill reverses that policy and would face significant opposition in a state with strong transgender healthcare protections.

Massachusetts

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Massachusetts prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Massachusetts General Court:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (M.G.L. ch. 119, § 21).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Massachusetts (M.G.L. ch. 112, § 2).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Massachusetts.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Massachusetts healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (M.G.L. ch. 118E, § 9).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Massachusetts may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (M.G.L. ch. 265, § 13J): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (M.G.L. ch. 265, § 25): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (M.G.L. ch. 268, § 13B): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (M.G.L. ch. 265, § 13A): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., M.G.L. ch. 277, § 63 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Massachusetts Board of Registration in Medicine or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (M.G.L. ch. 279, § 24).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 2.5 years imprisonment and/or a $5,000 fine (M.G.L. ch. 265, § 13J).

(2) Coercion: Up to 3 years imprisonment and/or a $1,000 fine (M.G.L. ch. 265, § 25).

(3) Misconduct: Up to 2.5 years imprisonment and/or a $5,000 fine (M.G.L. ch. 268, § 13B).

(4) Assault/Battery: Up to 2.5 years imprisonment and/or a $1,000 fine (M.G.L. ch. 265, § 13A).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Massachusetts Department of Public Health shall investigate alleged prospective violations of Section 3, and the Massachusetts Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Massachusetts Department of Public Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Massachusetts’s H 4885 (2022) protects gender-affirming care, ensuring access for minors with parental consent. This bill reverses that policy and would face significant opposition in a state with robust transgender protections.

Michigan

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Michigan prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Michigan Legislature:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (MCL 722.1).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Michigan (MCL 333.17001).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Michigan.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Michigan healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (MCL 400.105).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Michigan may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (MCL 750.145): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (MCL 750.213): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (MCL 750.505): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (MCL 750.81 - 750.84): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., MCL 767.24 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Michigan Board of Medicine or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (MCL 750.503).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 2 years imprisonment and/or a $2,000 fine (MCL 750.145).

(2) Coercion: Up to 7 years imprisonment (MCL 750.213).

(3) Misconduct: Up to 7 years imprisonment and/or a $7,500 fine (MCL 750.505).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $5,000 for severe cases (MCL 750.84).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Michigan Department of Health and Human Services shall investigate alleged prospective violations of Section 3, and the Michigan Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Michigan Department of Health and Human Services or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Michigan’s HB 4616 (2023) protects gender-affirming care, ensuring access for minors with parental consent. This bill reverses that policy and would face significant opposition in a state with progressive healthcare policies.

Minnesota

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Minnesota prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Minnesota Legislature:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (Minn. Stat. § 645.451).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Minnesota (Minn. Stat. § 147.081).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Minnesota.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Minnesota healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (Minn. Stat. § 256B.0625).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Minnesota may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (Minn. Stat. § 609.378): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (Minn. Stat. § 609.27): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (Minn. Stat. § 609.43): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (Minn. Stat. § 609.221 - 609.224): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., Minn. Stat. § 628.26 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Minnesota Board of Medical Practice or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (Minn. Stat. § 609.03).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 7 years imprisonment and/or a $14,000 fine (Minn. Stat. § 609.378).

(2) Coercion: Up to 3 years imprisonment and/or a $5,000 fine (Minn. Stat. § 609.27).

(3) Misconduct: Up to 1 year imprisonment and/or a $3,000 fine (Minn. Stat. § 609.43).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $14,000 for severe cases (Minn. Stat. § 609.221).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Minnesota Department of Health shall investigate alleged prospective violations of Section 3, and the Minnesota Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Minnesota Department of Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Minnesota’s HF 146 (2023) establishes the state as a sanctuary for gender-affirming care, protecting providers and families. This bill directly contradicts current law and would face significant legal and political opposition.

Mississippi

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Mississippi prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Mississippi Legislature:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (Miss. Code Ann. § 1-3-27).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Mississippi (Miss. Code Ann. § 73-25-1).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Mississippi.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Mississippi healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (Miss. Code Ann. § 43-13-117).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Mississippi may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (Miss. Code Ann. § 97-5-39): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (Miss. Code Ann. § 97-3-11): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (Miss. Code Ann. § 97-11-31): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (Miss. Code Ann. § 97-3-7): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., Miss. Code Ann. § 99-1-5 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Mississippi State Board of Medical Licensure or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (Miss. Code Ann. § 97-1-1).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 6 years imprisonment and/or a $3,000 fine (Miss. Code Ann. § 97-5-39).

(2) Coercion: Up to 7 years imprisonment and/or a $5,000 fine (Miss. Code Ann. § 97-3-11).

(3) Misconduct: Up to 1 year imprisonment and/or a $500 fine (Miss. Code Ann. § 97-11-31).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $5,000 for severe cases (Miss. Code Ann. § 97-3-7).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Mississippi State Department of Health shall investigate alleged prospective violations of Section 3, and the Mississippi Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Mississippi State Department of Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Mississippi’s HB 1128 (2023) bans gender-affirming care for minors, with penalties for providers. This bill aligns but adds retrospective prosecution, potentially facing challenges under Mississippi’s statute of limitations (Miss. Code Ann. § 99-1-5).

Missouri

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Missouri prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Missouri General Assembly:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (Mo. Rev. Stat. § 1.020).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Missouri (Mo. Rev. Stat. § 334.040).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Missouri.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Missouri healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (Mo. Rev. Stat. § 208.152).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Missouri may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (Mo. Rev. Stat. § 568.060): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (Mo. Rev. Stat. § 565.110): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (Mo. Rev. Stat. § 576.070): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (Mo. Rev. Stat. § 565.050 - 565.070): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., Mo. Rev. Stat. § 556.036 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Missouri Board of Registration for the Healing Arts or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (Mo. Rev. Stat. § 558.011).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 4 years imprisonment and/or a $5,000 fine (Mo. Rev. Stat. § 568.060).

(2) Coercion: Up to 7 years imprisonment and/or a $10,000 fine (Mo. Rev. Stat. § 565.110).

(3) Misconduct: Up to 1 year imprisonment and/or a $2,000 fine (Mo. Rev. Stat. § 576.070).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $10,000 for severe cases (Mo. Rev. Stat. § 565.050).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Missouri Department of Health and Senior Services shall investigate alleged prospective violations of Section 3, and the Missouri Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Missouri Department of Health and Senior Services or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Missouri’s SB 49 (2023) bans gender-affirming care for minors, with felony penalties for providers. This bill aligns but adds retrospective prosecution, which may face ex post facto challenges under Missouri’s constitution (Mo. Const. Art. I, § 13).

Montana

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Montana prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Montana Legislature:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (Mont. Code Ann. § 41-1-101).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Montana (Mont. Code Ann. § 50-5-101).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Montana.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Montana healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (Mont. Code Ann. § 53-6-113).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Montana may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (Mont. Code Ann. § 45-5-208): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (Mont. Code Ann. § 45-5-206): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (Mont. Code Ann. § 45-7-401): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (Mont. Code Ann. § 45-5-201 - 45-5-202): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., Mont. Code Ann. § 45-1-205 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Montana Board of Medical Examiners or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (Mont. Code Ann. § 45-5-102).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 1 year imprisonment and/or a $1,000 fine (Mont. Code Ann. § 45-5-208).

(2) Coercion: Up to 7 years imprisonment and/or a $5,000 fine (Mont. Code Ann. § 45-5-206).

(3) Misconduct: Up to 6 months imprisonment and/or a $500 fine (Mont. Code Ann. § 45-7-401).

(4) Assault/Battery: Varies by degree, up to 5 years and/or $5,000 for severe cases (Mont. Code Ann. § 45-5-202).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Montana Department of Public Health and Human Services shall investigate alleged prospective violations of Section 3, and the Montana Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Montana Department of Public Health and Human Services or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Montana’s SB 99 (2023) bans gender-affirming care for minors, with penalties for providers. This bill aligns but adds retrospective prosecution, potentially facing challenges under Montana’s statute of limitations (Mont. Code Ann. § 45-1-205).

Nebraska

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Nebraska prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Nebraska Legislature:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 19 years (Neb. Rev. Stat. § 43-2101).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Nebraska (Neb. Rev. Stat. § 38-101).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Nebraska.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Nebraska healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (Neb. Rev. Stat. § 68-901).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Nebraska may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (Neb. Rev. Stat. § 28-707): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (Neb. Rev. Stat. § 28-313): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (Neb. Rev. Stat. § 28-924): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (Neb. Rev. Stat. § 28-308 - 28-310): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., Neb. Rev. Stat. § 29-110 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 19 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Nebraska Board of Medicine and Surgery or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (Neb. Rev. Stat. § 28-105).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 7 years imprisonment and/or a $15,000 fine (Neb. Rev. Stat. § 28-707).

(2) Coercion: Up to 7 years imprisonment and/or a $15,000 fine (Neb. Rev. Stat. § 28-313).

(3) Misconduct: Up to 1 year imprisonment and/or a $1,000 fine (Neb. Rev. Stat. § 28-924).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $15,000 for severe cases (Neb. Rev. Stat. § 28-308).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Nebraska Department of Health and Human Services shall investigate alleged prospective violations of Section 3, and the Nebraska Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Nebraska Department of Health and Human Services or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Nebraska’s LB 574 (2023) bans gender-affirming care for minors, with penalties for providers. This bill aligns but adds retrospective prosecution, potentially facing challenges under Nebraska’s statute of limitations (Neb. Rev. Stat. § 29-110).

Nevada

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Nevada prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Nevada Legislature:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (NRS 129.010).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Nevada (NRS 630.060).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Nevada.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Nevada healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (NRS 422.270).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Nevada may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (NRS 200.508): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (NRS 207.190): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (NRS 197.110): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (NRS 200.400 - 200.471): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., NRS 171.085 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Nevada State Board of Medical Examiners or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (NRS 193.130).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 7 years imprisonment and/or a $5,000 fine (NRS 200.508).

(2) Coercion: Up to 1 year imprisonment and/or a $2,000 fine (NRS 207.190).

(3) Misconduct: Up to 1 year imprisonment and/or a $2,000 fine (NRS 197.110).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $10,000 for severe cases (NRS 200.471).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Nevada Division of Public and Behavioral Health shall investigate alleged prospective violations of Section 3, and the Nevada Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Nevada Division of Public and Behavioral Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Nevada’s SB 302 (2023) protects gender-affirming care, ensuring access for minors with parental consent. This bill reverses that policy and would face significant opposition in a state with progressive healthcare laws.

New Hampshire

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of New Hampshire prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the New Hampshire General Court:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (RSA 21:44).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of New Hampshire (RSA 329:1).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of New Hampshire.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other New Hampshire healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (RSA 167:3-c).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of New Hampshire may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (RSA 639:3): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (RSA 633:4): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (RSA 643:1): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (RSA 631:2 - 631:3): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., RSA 625:8 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the New Hampshire Board of Medicine or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (RSA 625:9).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 1 year imprisonment and/or a $2,000 fine (RSA 639:3).

(2) Coercion: Up to 7 years imprisonment and/or a $4,000 fine (RSA 633:4).

(3) Misconduct: Up to 1 year imprisonment and/or a $2,000 fine (RSA 643:1).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $4,000 for severe cases (RSA 631:2).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The New Hampshire Department of Health and Human Services shall investigate alleged prospective violations of Section 3, and the New Hampshire Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the New Hampshire Department of Health and Human Services or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: New Hampshire has no specific ban on gender-affirming care for minors as of 2023, but HB 619 (2023) proposed restrictions. This bill introduces a comprehensive ban and retrospective prosecution, likely facing opposition in a state with moderate healthcare policies.

New Jersey

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of New Jersey prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the New Jersey Legislature:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (N.J.S.A. 9:17B-3).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of New Jersey (N.J.S.A. 45:9-1).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of New Jersey.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other New Jersey healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (N.J.S.A. 30:4D-6).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of New Jersey may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (N.J.S.A. 2C:24-4): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (N.J.S.A. 2C:13-5): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (N.J.S.A. 2C:30-2): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (N.J.S.A. 2C:12-1): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., N.J.S.A. 2C:1-6 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the New Jersey Board of Medical Examiners or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (N.J.S.A. 2C:43-6).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 7 years imprisonment and/or a $15,000 fine (N.J.S.A. 2C:24-4).

(2) Coercion: Up to 7 years imprisonment and/or a $15,000 fine (N.J.S.A. 2C:13-5).

(3) Misconduct: Up to 3 years imprisonment and/or a $10,000 fine (N.J.S.A. 2C:30-2).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $15,000 for severe cases (N.J.S.A. 2C:12-1).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The New Jersey Department of Health shall investigate alleged prospective violations of Section 3, and the New Jersey Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the New Jersey Department of Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: New Jersey’s S 3075 (2023) protects gender-affirming care, ensuring access for minors with parental consent. This bill reverses that policy and would face significant opposition in a state with strong transgender healthcare protections.

New Mexico

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of New Mexico prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the New Mexico Legislature:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (NMSA 1978, § 12-2A-3).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of New Mexico (NMSA 1978, § 61-6-6).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of New Mexico.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other New Mexico healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (NMSA 1978, § 27-2-12).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of New Mexico may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (NMSA 1978, § 30-6-1): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (NMSA 1978, § 30-16-9): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (NMSA 1978, § 30-23-1): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (NMSA 1978, § 30-3-1 - 30-3-5): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., NMSA 1978, § 30-1-8 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the New Mexico Medical Board or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (NMSA 1978, § 31-18-15).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 3 years imprisonment and/or a $5,000 fine (NMSA 1978, § 30-6-1).

(2) Coercion: Up to 1 year imprisonment and/or a $1,000 fine (NMSA 1978, § 30-16-9).

(3) Misconduct: Up to 1 year imprisonment and/or a $1,000 fine (NMSA 1978, § 30-23-1).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $5,000 for severe cases (NMSA 1978, § 30-3-5).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The New Mexico Department of Health shall investigate alleged prospective violations of Section 3, and the New Mexico Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the New Mexico Department of Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: New Mexico’s SB 13 (2023) protects gender-affirming care, ensuring access for minors with parental consent. This bill reverses that policy and would face significant opposition in a state with progressive healthcare laws.

New York

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of New York prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the New York State Legislature:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (N.Y. Dom. Rel. Law § 2).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of New York (N.Y. Educ. Law § 6521).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of New York.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other New York healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (N.Y. Soc. Serv. Law § 363).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of New York may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (N.Y. Penal Law § 260.10): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (N.Y. Penal Law § 135.60): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (N.Y. Penal Law § 195.00): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (N.Y. Penal Law § 120.00 - 120.05): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., N.Y. Crim. Proc. Law § 30.10 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the New York State Board for Medicine or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (N.Y. Penal Law § 70.00).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 1 year imprisonment and/or a $1,000 fine (N.Y. Penal Law § 260.10).

(2) Coercion: Up to 1 year imprisonment and/or a $1,000 fine (N.Y. Penal Law § 135.60).

(3) Misconduct: Up to 1 year imprisonment and/or a $1,000 fine (N.Y. Penal Law § 195.00).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $5,000 for severe cases (N.Y. Penal Law § 120.05).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The New York State Department of Health shall investigate alleged prospective violations of Section 3, and the New York Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the New York State Department of Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: New York’s S 7475 (2023) protects gender-affirming care, ensuring access for minors with parental consent. This bill reverses that policy and would face significant opposition in a state with strong transgender healthcare protections.

North Carolina

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of North Carolina prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the North Carolina General Assembly:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (N.C. Gen. Stat. § 48A-2).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of North Carolina (N.C. Gen. Stat. § 90-21.5).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of North Carolina.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other North Carolina healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (N.C. Gen. Stat. § 108A-54).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of North Carolina may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (N.C. Gen. Stat. § 14-318.4): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (N.C. Gen. Stat. § 14-39): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (N.C. Gen. Stat. § 14-228): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (N.C. Gen. Stat. § 14-33): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., N.C. Gen. Stat. § 15-1 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the North Carolina Medical Board or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (N.C. Gen. Stat. § 14-7.1).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 7 years imprisonment (N.C. Gen. Stat. § 14-318.4).

(2) Coercion: Up to 7 years imprisonment (N.C. Gen. Stat. § 14-39).

(3) Misconduct: Up to 120 days imprisonment (N.C. Gen. Stat. § 14-228).

(4) Assault/Battery: Varies by degree, up to 150 days for misdemeanor cases (N.C. Gen. Stat. § 14-33).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The North Carolina Department of Health and Human Services shall investigate alleged prospective violations of Section 3, and the North Carolina Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the North Carolina Department of Health and Human Services or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: North Carolina’s HB 808 (2023) bans gender-affirming care for minors, with penalties for providers. This bill aligns but adds retrospective prosecution, potentially facing challenges under North Carolina’s statute of limitations (N.C. Gen. Stat. § 15-1).

North Dakota

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of North Dakota prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the North Dakota Legislative Assembly:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (N.D. Cent. Code § 14-10-01).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of North Dakota (N.D. Cent. Code § 43-17-01).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of North Dakota.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other North Dakota healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (N.D. Cent. Code § 50-24.1-02).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of North Dakota may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (N.D. Cent. Code § 12.1-16-03): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (N.D. Cent. Code § 12.1-17-06): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (N.D. Cent. Code § 12.1-11-06): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (N.D. Cent. Code § 12.1-17-01 - 12.1-17-02): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., N.D. Cent. Code § 29-04-02 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the North Dakota Board of Medicine or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (N.D. Cent. Code § 12.1-32-01).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 5 years imprisonment and/or a $10,000 fine (N.D. Cent. Code § 12.1-16-03).

(2) Coercion: Up to 1 year imprisonment and/or a $2,000 fine (N.D. Cent. Code § 12.1-17-06).

(3) Misconduct: Up to 1 year imprisonment and/or a $2,000 fine (N.D. Cent. Code § 12.1-11-06).

(4) Assault/Battery: Varies by degree, up to 5 years and/or $10,000 for severe cases (N.D. Cent. Code § 12.1-17-02).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The North Dakota Department of Health and Human Services shall investigate alleged prospective violations of Section 3, and the North Dakota Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the North Dakota Department of Health and Human Services or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: North Dakota’s HB 1254 (2023) bans gender-affirming care for minors, with felony penalties for providers. This bill aligns but adds retrospective prosecution, potentially facing challenges under North Dakota’s statute of limitations (N.D. Cent. Code § 29-04-02).

Ohio

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Ohio prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Ohio General Assembly:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (Ohio Rev. Code § 3109.01).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Ohio (Ohio Rev. Code § 4731.02).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Ohio.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Ohio healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (Ohio Rev. Code § 5164.01).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Ohio may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (Ohio Rev. Code § 2919.22): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (Ohio Rev. Code § 2905.12): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (Ohio Rev. Code § 2921.43): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (Ohio Rev. Code § 2903.13 - 2903.14): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., Ohio Rev. Code § 2901.13 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the State Medical Board of Ohio or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (Ohio Rev. Code § 2929.14).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 7 years imprisonment and/or a $15,000 fine (Ohio Rev. Code § 2919.22).

(2) Coercion: Up to 1 year imprisonment and/or a $2,500 fine (Ohio Rev. Code § 2905.12).

(3) Misconduct: Up to 180 days imprisonment and/or a $1,000 fine (Ohio Rev. Code § 2921.43).

(4) Assault/Battery: Varies by degree, up to 1 year and/or $2,500 for misdemeanor cases (Ohio Rev. Code § 2903.13).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Ohio Department of Health shall investigate alleged prospective violations of Section 3, and the Ohio Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Ohio Department of Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Ohio’s HB 68 (2023) bans gender-affirming care for minors, with penalties for providers. This bill aligns but adds retrospective prosecution, potentially facing challenges under Ohio’s statute of limitations (Ohio Rev. Code § 2901.13).

Oklahoma

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Oklahoma prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Oklahoma Legislature:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (Okla. Stat. tit. 15, § 13).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Oklahoma (Okla. Stat. tit. 59, § 492).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Oklahoma.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Oklahoma healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (Okla. Stat. tit. 56, § 4002.3).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Oklahoma may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (Okla. Stat. tit. 21, § 852): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (Okla. Stat. tit. 21, § 422): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (Okla. Stat. tit. 21, § 344): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (Okla. Stat. tit. 21, § 641 - 644): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., Okla. Stat. tit. 22, § 152 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Oklahoma State Board of Medical Licensure and Supervision or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (Okla. Stat. tit. 21, § 13.1).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 1 year imprisonment and/or a $3,000 fine (Okla. Stat. tit. 21, § 852).

(2) Coercion: Up to 1 year imprisonment and/or a $500 fine (Okla. Stat. tit. 21, § 422).

(3) Misconduct: Up to 1 year imprisonment and/or a $500 fine (Okla. Stat. tit. 21, § 344).

(4) Assault/Battery: Varies by degree, up to 1 year and/or $1,000 for misdemeanor cases (Okla. Stat. tit. 21, § 644).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Oklahoma State Department of Health shall investigate alleged prospective violations of Section 3, and the Oklahoma Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Oklahoma State Department of Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Oklahoma’s SB 613 (2023) bans gender-affirming care for minors, with felony penalties for providers. This bill aligns but adds retrospective prosecution, potentially facing ex post facto challenges under Oklahoma’s constitution (Okla. Const. Art. 2, § 15).

Oregon

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Oregon prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Oregon Legislative Assembly:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (ORS 109.510).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Oregon (ORS 677.085).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Oregon.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Oregon healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (ORS 414.025).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Oregon may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (ORS 163.545): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (ORS 163.275): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (ORS 162.415): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (ORS 163.160 - 163.165): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., ORS 131.125 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Oregon Medical Board or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (ORS 161.605).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 1 year imprisonment and/or a $6,250 fine (ORS 163.545).

(2) Coercion: Up to 7 years imprisonment and/or a $125,000 fine (ORS 163.275).

(3) Misconduct: Up to 1 year imprisonment and/or a $6,250 fine (ORS 162.415).

(4) Assault/Battery: Varies by degree, up to 5 years and/or $125,000 for felony cases (ORS 163.165).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Oregon Health Authority shall investigate alleged prospective violations of Section 3, and the Oregon Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Oregon Health Authority or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Oregon’s HB 2002 (2023) protects gender-affirming care, ensuring access for minors with parental consent. This bill reverses that policy and would face significant opposition in a state with progressive healthcare laws.

Pennsylvania

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the Commonwealth of Pennsylvania prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the General Assembly of the Commonwealth of Pennsylvania:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (23 Pa.C.S. § 5101).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Pennsylvania (63 Pa.C.S. § 422.2).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the Commonwealth of Pennsylvania.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Pennsylvania healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (62 Pa.C.S. § 403).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the Commonwealth of Pennsylvania may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (18 Pa.C.S. § 4304): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (18 Pa.C.S. § 2906): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (18 Pa.C.S. § 4701): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (18 Pa.C.S. § 2701 - 2702): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., 42 Pa.C.S. § 5552 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Pennsylvania State Board of Medicine or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (18 Pa.C.S. § 1103).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 2 years imprisonment and/or a $5,000 fine (18 Pa.C.S. § 4304).

(2) Coercion: Up to 7 years imprisonment and/or a $15,000 fine (18 Pa.C.S. § 2906).

(3) Misconduct: Up to 2 years imprisonment and/or a $5,000 fine (18 Pa.C.S. § 4701).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $15,000 for felony cases (18 Pa.C.S. § 2702).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Pennsylvania Department of Health shall investigate alleged prospective violations of Section 3, and the Pennsylvania Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Pennsylvania Department of Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Pennsylvania has no specific ban on gender-affirming care for minors as of 2023, but HB 138 (2023) proposed restrictions. This bill introduces a comprehensive ban and retrospective prosecution, likely facing opposition in a state with moderate healthcare policies.

Rhode Island

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Rhode Island prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the General Assembly of the State of Rhode Island:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (R.I. Gen. Laws § 15-5-16.2).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Rhode Island (R.I. Gen. Laws § 5-37-1).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Rhode Island.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Rhode Island healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (R.I. Gen. Laws § 40-8.2-2).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Rhode Island may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (R.I. Gen. Laws § 11-9-5): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (R.I. Gen. Laws § 11-37-3): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (R.I. Gen. Laws § 11-7-3): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (R.I. Gen. Laws § 11-5-3): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., R.I. Gen. Laws § 12-12-17 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Rhode Island Board of Medical Licensure and Discipline or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (R.I. Gen. Laws § 12-29-5).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 1 year imprisonment and/or a $500 fine (R.I. Gen. Laws § 11-9-5).

(2) Coercion: Up to 7 years imprisonment (R.I. Gen. Laws § 11-37-3).

(3) Misconduct: Up to 1 year imprisonment and/or a $500 fine (R.I. Gen. Laws § 11-7-3).

(4) Assault/Battery: Up to 1 year imprisonment and/or a $1,000 fine (R.I. Gen. Laws § 11-5-3).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Rhode Island Department of Health shall investigate alleged prospective violations of Section 3, and the Rhode Island Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Rhode Island Department of Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Rhode Island’s H 6042 (2023) protects gender-affirming care, ensuring access for minors with parental consent. This bill reverses that policy and would face significant opposition in a state with progressive healthcare laws.

South Carolina

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of South Carolina prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the General Assembly of the State of South Carolina:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (S.C. Code Ann. § 63-1-40).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of South Carolina (S.C. Code Ann. § 40-47-20).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of South Carolina.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other South Carolina healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (S.C. Code Ann. § 44-7-110).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of South Carolina may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (S.C. Code Ann. § 63-5-70): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (S.C. Code Ann. § 16-3-1400): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (S.C. Code Ann. § 8-1-80): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (S.C. Code Ann. § 16-3-600): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., S.C. Code Ann. § 17-3-510 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the South Carolina Board of Medical Examiners or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (S.C. Code Ann. § 16-1-90).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 3 years imprisonment and/or a $3,000 fine (S.C. Code Ann. § 63-5-70).

(2) Coercion: Up to 5 years imprisonment (S.C. Code Ann. § 16-3-1400).

(3) Misconduct: Up to 1 year imprisonment and/or a $500 fine (S.C. Code Ann. § 8-1-80).

(4) Assault/Battery: Varies by degree, up to 3 years and/or $2,500 for misdemeanor cases (S.C. Code Ann. § 16-3-600).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The South Carolina Department of Health and Environmental Control shall investigate alleged prospective violations of Section 3, and the South Carolina Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the South Carolina Department of Health and Environmental Control or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: South Carolina’s H 4624 (2023) bans gender-affirming care for minors, with penalties for providers. This bill aligns but adds retrospective prosecution, potentially facing challenges under South Carolina’s statute of limitations (S.C. Code Ann. § 17-3-510).

South Dakota

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of South Dakota prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the South Dakota Legislature:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (SDCL § 26-1-1).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of South Dakota (SDCL § 36-4-8).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of South Dakota.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other South Dakota healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (SDCL § 28-6-1).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of South Dakota may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (SDCL § 26-10-1): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (SDCL § 22-19-1): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (SDCL § 22-11-1): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (SDCL § 22-18-1): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., SDCL § 23A-42-2 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the South Dakota Board of Medical and Osteopathic Examiners or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (SDCL § 22-6-1).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 2 years imprisonment and/or a $4,000 fine (SDCL § 26-10-1).

(2) Coercion: Up to 2 years imprisonment and/or a $4,000 fine (SDCL § 22-19-1).

(3) Misconduct: Up to 1 year imprisonment and/or a $2,000 fine (SDCL § 22-11-1).

(4) Assault/Battery: Varies by degree, up to 1 year and/or $2,000 for misdemeanor cases (SDCL § 22-18-1).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The South Dakota Department of Health shall investigate alleged prospective violations of Section 3, and the South Dakota Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the South Dakota Department of Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: South Dakota’s HB 1080 (2023) bans gender-affirming care for minors, with penalties for providers. This bill aligns but adds retrospective prosecution, potentially facing challenges under South Dakota’s statute of limitations (SDCL § 23A-42-2).

Tennessee

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Tennessee prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Tennessee General Assembly:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (Tenn. Code Ann. § 1-3-105).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Tennessee (Tenn. Code Ann. § 63-6-201).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Tennessee.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Tennessee healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (Tenn. Code Ann. § 71-5-105).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Tennessee may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (Tenn. Code Ann. § 39-15-401): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (Tenn. Code Ann. § 39-13-514): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (Tenn. Code Ann. § 39-16-402): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (Tenn. Code Ann. § 39-13-101 - 39-13-102): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., Tenn. Code Ann. § 40-2-101 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Tennessee Board of Medical Examiners or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (Tenn. Code Ann. § 40-35-111).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 2 years imprisonment and/or a $5,000 fine (Tenn. Code Ann. § 39-15-401).

(2) Coercion: Up to 7 years imprisonment and/or a $5,000 fine (Tenn. Code Ann. § 39-13-514).

(3) Misconduct: Up to 2 years imprisonment and/or a $5,000 fine (Tenn. Code Ann. § 39-16-402).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $5,000 for felony cases (Tenn. Code Ann. § 39-13-102).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Tennessee Department of Health shall investigate alleged prospective violations of Section 3, and the Tennessee Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Tennessee Department of Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Tennessee’s SB 1 (2023) bans gender-affirming care for minors, with felony penalties for providers. This bill aligns but adds retrospective prosecution, potentially facing ex post facto challenges under Tennessee’s constitution (Tenn. Const. Art. I, § 11).

Texas

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Texas prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Texas Legislature:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (Tex. Fam. Code § 101.003).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Texas (Tex. Occ. Code § 151.002).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Texas.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Texas healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (Tex. Hum. Res. Code § 32.024).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Texas may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (Tex. Penal Code § 22.04): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (Tex. Penal Code § 1.07(a)(9)): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (Tex. Penal Code § 39.02): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (Tex. Penal Code § 22.01 - 22.02): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., Tex. Code Crim. Proc. art. 12.01 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Texas Medical Board or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (Tex. Penal Code § 12.34).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 7 years imprisonment and/or a $10,000 fine (Tex. Penal Code § 22.04).

(2) Coercion: Up to 7 years imprisonment and/or a $10,000 fine (Tex. Penal Code § 1.07(a)(9)).

(3) Misconduct: Up to 1 year imprisonment and/or a $4,000 fine (Tex. Penal Code § 39.02).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $10,000 for felony cases (Tex. Penal Code § 22.02).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Texas Health and Human Services Commission shall investigate alleged prospective violations of Section 3, and the Texas Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Texas Health and Human Services Commission or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Texas’s SB 14 (2023) bans gender-affirming care for minors, with felony penalties for providers. This bill aligns but adds retrospective prosecution, potentially facing ex post facto challenges under Texas’s constitution (Tex. Const. Art. I, § 16).

Utah

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Utah prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Utah Legislature:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (Utah Code Ann. § 78A-6-105).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Utah (Utah Code Ann. § 58-1-102).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Utah.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Utah healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (Utah Code Ann. § 26-18-3).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Utah may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (Utah Code Ann. § 76-5-110): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (Utah Code Ann. § 76-5-108): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (Utah Code Ann. § 76-8-201): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (Utah Code Ann. § 76-5-102 - 76-5-103): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., Utah Code Ann. § 76-1-302 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Utah Division of Occupational and Professional Licensing or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (Utah Code Ann. § 76-3-203).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 1 year imprisonment and/or a $2,500 fine (Utah Code Ann. § 76-5-110).

(2) Coercion: Up to 7 years imprisonment and/or a $5,000 fine (Utah Code Ann. § 76-5-108).

(3) Misconduct: Up to 1 year imprisonment and/or a $2,500 fine (Utah Code Ann. § 76-8-201).

(4) Assault/Battery: Varies by degree, up to 5 years and/or $5,000 for felony cases (Utah Code Ann. § 76-5-103).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Utah Department of Health and Human Services shall investigate alleged prospective violations of Section 3, and the Utah Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Utah Department of Health and Human Services or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Utah’s SB 16 (2023) bans gender-affirming care for minors, with penalties for providers. This bill aligns but adds retrospective prosecution, potentially facing challenges under Utah’s statute of limitations (Utah Code Ann. § 76-1-302).

Vermont

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Vermont prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Vermont General Assembly:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (33 V.S.A. § 5102).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Vermont (26 V.S.A. § 1311).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Vermont.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Vermont healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (33 V.S.A. § 1901).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Vermont may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (13 V.S.A. § 1304): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (13 V.S.A. § 11): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (13 V.S.A. § 3006): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (13 V.S.A. § 1023 - 1024): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., 13 V.S.A. § 4501 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Vermont Board of Medical Practice or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (13 V.S.A. § 1).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 2 years imprisonment and/or a $2,000 fine (13 V.S.A. § 1304).

(2) Coercion: Up to 7 years imprisonment and/or a $5,000 fine (13 V.S.A. § 11).

(3) Misconduct: Up to 1 year imprisonment and/or a $1,000 fine (13 V.S.A. § 3006).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $5,000 for felony cases (13 V.S.A. § 1024).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Vermont Department of Health shall investigate alleged prospective violations of Section 3, and the Vermont Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Vermont Department of Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Vermont’s H 89 (2023) protects gender-affirming care, ensuring access for minors with parental consent. This bill reverses that policy and would face significant opposition in a state with progressive healthcare laws.

Virginia

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the Commonwealth of Virginia prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the General Assembly of Virginia:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (Va. Code Ann. § 1-207).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Virginia (Va. Code Ann. § 54.1-2900).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the Commonwealth of Virginia.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Virginia healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (Va. Code Ann. § 32.1-325).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the Commonwealth of Virginia may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (Va. Code Ann. § 18.2-369): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (Va. Code Ann. § 18.2-59): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (Va. Code Ann. § 18.2-446): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (Va. Code Ann. § 18.2-57): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., Va. Code Ann. § 19.2-8 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Virginia Board of Medicine or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (Va. Code Ann. § 18.2-10).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 7 years imprisonment and/or a $2,500 fine (Va. Code Ann. § 18.2-369).

(2) Coercion: Up to 1 year imprisonment and/or a $2,500 fine (Va. Code Ann. § 18.2-59).

(3) Misconduct: Up to 1 year imprisonment and/or a $2,500 fine (Va. Code Ann. § 18.2-446).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $2,500 for felony cases (Va. Code Ann. § 18.2-57).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Virginia Department of Health shall investigate alleged prospective violations of Section 3, and the Virginia Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Virginia Department of Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Virginia has no specific ban on gender-affirming care for minors as of 2023, but HB 1686 (2023) proposed restrictions. This bill introduces a comprehensive ban and retrospective prosecution, likely facing opposition in a state with moderate healthcare policies.

Washington

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Washington prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Washington State Legislature:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (RCW 26.28.015).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Washington (RCW 18.130.040).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Washington.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Washington healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (RCW 74.09.520).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Washington may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (RCW 9A.42.035): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (RCW 9A.36.070): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (RCW 9A.80.010): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (RCW 9A.36.021 - 9A.36.031): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., RCW 9A.04.080 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Washington Medical Commission or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (RCW 9A.20.021).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 1 year imprisonment and/or a $3,000 fine (RCW 9A.42.035).

(2) Coercion: Up to 1 year imprisonment and/or a $5,000 fine (RCW 9A.36.070).

(3) Misconduct: Up to 1 year imprisonment and/or a $5,000 fine (RCW 9A.80.010).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $10,000 for felony cases (RCW 9A.36.021).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Washington State Department of Health shall investigate alleged prospective violations of Section 3, and the Washington Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Washington State Department of Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Washington’s SB 5599 (2023) protects gender-affirming care, ensuring access for minors with parental consent. This bill reverses that policy and would face significant opposition in a state with progressive healthcare laws.

West Virginia

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of West Virginia prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the West Virginia Legislature:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (W. Va. Code § 2-2-10).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of West Virginia (W. Va. Code § 30-3-4).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of West Virginia.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other West Virginia healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (W. Va. Code § 9-5-12).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of West Virginia may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (W. Va. Code § 61-8D-4): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (W. Va. Code § 61-2-13): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (W. Va. Code § 61-5-28): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (W. Va. Code § 61-2-9): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., W. Va. Code § 61-11-9 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the West Virginia Board of Medicine or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (W. Va. Code § 61-12-8).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 3 years imprisonment and/or a $3,000 fine (W. Va. Code § 61-8D-4).

(2) Coercion: Up to 1 year imprisonment and/or a $500 fine (W. Va. Code § 61-2-13).

(3) Misconduct: Up to 1 year imprisonment and/or a $1,000 fine (W. Va. Code § 61-5-28).

(4) Assault/Battery: Varies by degree, up to 1 year and/or $1,000 for misdemeanor cases (W. Va. Code § 61-2-9).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The West Virginia Department of Health and Human Resources shall investigate alleged prospective violations of Section 3, and the West Virginia Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the West Virginia Department of Health and Human Resources or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: West Virginia’s HB 2007 (2023) bans gender-affirming care for minors, with penalties for providers. This bill aligns but adds retrospective prosecution, potentially facing challenges under West Virginia’s statute of limitations (W. Va. Code § 61-11-9).

Wisconsin

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Wisconsin prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Wisconsin Legislature:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (Wis. Stat. § 48.02).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Wisconsin (Wis. Stat. § 146.81).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Wisconsin.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Wisconsin healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (Wis. Stat. § 49.43).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Wisconsin may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (Wis. Stat. § 948.21): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (Wis. Stat. § 940.30): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (Wis. Stat. § 946.12): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (Wis. Stat. § 940.19): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., Wis. Stat. § 939.74 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Wisconsin Medical Examining Board or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (Wis. Stat. § 939.50).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 3.5 years imprisonment and/or a $10,000 fine (Wis. Stat. § 948.21).

(2) Coercion: Up to 7 years imprisonment and/or a $100,000 fine (Wis. Stat. § 940.30).

(3) Misconduct: Up to 3.5 years imprisonment and/or a $10,000 fine (Wis. Stat. § 946.12).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $10,000 for felony cases (Wis. Stat. § 940.19).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Wisconsin Department of Health Services shall investigate alleged prospective violations of Section 3, and the Wisconsin Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Wisconsin Department of Health Services or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Wisconsin has no specific ban on gender-affirming care for minors as of 2023, but AB 465 (2023) proposed restrictions. This bill introduces a comprehensive ban and retrospective prosecution, likely facing opposition in a state with moderate healthcare policies.

Wyoming

House Bill No. [XXXX]

A BILL

To prohibit gender-affirming medical care and certain counseling for minors in the State of Wyoming prospectively, to enable prosecution of past gender-affirming care under existing criminal medical codes where applicable, to declare that medical consent cannot be obtained for such care prospectively, to establish additional violations and penalties, and for other purposes.

Be it enacted by the Wyoming Legislature:

Section 1. Short Title

This Act may be cited as "The Zywiec Act."

Section 2. Definitions

For purposes of this Act:

(a) "Minor" means an individual under the age of 18 years (Wyo. Stat. Ann. § 14-1-101).

(b) "Gender-affirming care" means any medical or surgical intervention, including but not limited to hormone therapy, puberty blockers, or gender reassignment surgery, intended to affirm an individual’s perceived gender identity when it differs from their biological sex as determined at birth.

(c) "Healthcare provider" means any licensed physician, surgeon, nurse practitioner, pharmacist, or other individual authorized to provide or facilitate medical care under the laws of Wyoming (Wyo. Stat. Ann. § 33-26-102).

(d) "Biological sex" means the sex assigned at birth based on chromosomes, gonads, and genitalia.

(e) "Intersex condition" means a congenital condition in which an individual is born with reproductive or sexual anatomy that does not fit typical definitions of male or female, including but not limited to ambiguous genitalia, as diagnosed by a licensed healthcare provider.

(f) "Consent" means the informed, voluntary, and legally valid agreement of a minor’s legal guardian; however, for the purposes of gender-affirming care, no such consent shall be deemed valid under this Act after the effective date.

Section 3. Prospective Prohibition of Gender-Affirming Care and Certain Counseling for Minors

(a) Prohibition: Beginning on the effective date of this Act, no healthcare provider shall knowingly provide gender-affirming care to a minor within the State of Wyoming.

(b) Invalidity of Consent: After the effective date, consent from a minor or their legal guardian shall not be recognized as valid for gender-affirming care, as such care is deemed inherently unlawful and against public policy under this Act. Any attempt to obtain or rely on such consent shall constitute a violation.

(c) Public Funding: No public funds, including Medical Assistance or other Wyoming healthcare programs, shall be used to provide gender-affirming care to a minor after the effective date (Wyo. Stat. Ann. § 42-4-101).

(d) Additional Violations: In addition to providing gender-affirming care, the following acts are prohibited after the effective date:

(1) Attempting to Provide: Attempting to administer, prescribe, or schedule gender-affirming care for a minor.

(2) Facilitation: Assisting, referring, or facilitating access to gender-affirming care for a minor, including by out-of-state providers.

(3) Documentation Fraud: Falsifying medical records, diagnoses, or consent forms to justify or conceal gender-affirming care for a minor.

(4) Coercion: Pressuring, coercing, or unduly influencing a minor or their legal guardian to pursue or consent to gender-affirming care.

(e) Exceptions: This prospective prohibition does not apply to:

(1) Treatment of a minor for a diagnosed medical condition unrelated to gender identity, such as precocious puberty, when such treatment is deemed medically necessary by a licensed healthcare provider and approved by the minor’s legal guardian;

(2) Mental health counseling or therapy that does not involve medical or surgical intervention, provided that such counseling does not suggest, encourage, or affirm that the minor is any gender other than their biological sex as determined at birth; or

(3) Surgical or medical interventions for a minor with an intersex condition, when such interventions are deemed medically necessary by a licensed healthcare provider to correct ambiguous genitalia or other physical anomalies directly related to the intersex condition, and are approved by the minor’s legal guardian, provided that the intervention is not intended to affirm a gender identity differing from the minor’s biological sex as determined by genetic or anatomical evidence.

Section 4. Retrospective Application of Existing Criminal Medical Codes

(a) Criminal Liability under Existing Law: Any healthcare provider who, prior to the effective date of this Act, provided gender-affirming care to a minor in the State of Wyoming may be prosecuted under existing criminal statutes if the care violated such laws at the time it was performed. This Act does not create new criminal offenses for past acts but clarifies the applicability of the following:

(1) Criminal Neglect (Wyo. Stat. Ann. § 6-2-503): If the care constituted gross negligence resulting in significant bodily harm or endangerment to the minor’s health, as defined at the time.

(2) Coercion (Wyo. Stat. Ann. § 6-2-303): If the minor or their legal guardian was coerced into consenting to gender-affirming care through threats, force, or undue influence.

(3) Misconduct of Public Officer or Employee (Wyo. Stat. Ann. § 6-5-107): If public funds were knowingly misused to provide gender-affirming care in violation of then-existing regulations.

(4) Assault or Battery (Wyo. Stat. Ann. § 6-2-502): If the care was provided without valid consent (e.g., fraudulently obtained or absent) and resulted in bodily harm, constituting assault or battery under laws in effect at the time.

(b) Conditions for Prosecution: Prosecution under this section requires:

(1) Evidence that the gender-affirming care violated a specific criminal statute in effect at the time it was provided;

(2) Proof of harm, lack of valid consent, or other elements required by the applicable statute.

(c) Statute of Limitations: Prosecutions under this section shall adhere to the statutes of limitations in effect for the relevant crimes at the time of the act, unless extended by existing law (e.g., Wyo. Stat. Ann. § 6-1-303 for crimes against minors).

(d) Civil Liability Option: Where criminal prosecution is not applicable, civil actions for medical negligence, battery, or fraud may be pursued under laws in effect at the time of the act, with a statute of limitations of 10 years from the date the minor reaches 18 or 5 years from the effective date of this Act, whichever is later.

Section 5. Penalties

(a) Prospective Violations (Section 3): Any healthcare provider found in violation of Section 3(a), 3(b), or 3(d) shall:

(1) Be subject to a civil fine of not less than $500,000 per violation;

(2) Have their professional license revoked by the Wyoming Board of Medicine or relevant licensing authority; and

(3) Be subject to imprisonment for a term of up to 10 years (Wyo. Stat. Ann. § 6-1-104).

(b) Specific Penalties for Additional Prospective Violations:

(1) Attempting to Provide: Imprisonment for up to 5 years and a fine of $250,000 per offense.

(2) Facilitation: Imprisonment for up to 7 years and a fine of $350,000 per offense.

(3) Documentation Fraud: Imprisonment for up to 10 years and a fine of $500,000 per offense.

(4) Coercion: Imprisonment for up to 12 years and a fine of $750,000 per offense.

(c) Retrospective Violations (Section 4): Penalties for convictions under existing criminal codes shall follow the punishments prescribed by those statutes at the time of the offense, which may include:

(1) Criminal Neglect: Up to 3 years imprisonment and/or a $3,000 fine (Wyo. Stat. Ann. § 6-2-503).

(2) Coercion: Up to 7 years imprisonment and/or a $7,000 fine (Wyo. Stat. Ann. § 6-2-303).

(3) Misconduct: Up to 1 year imprisonment and/or a $2,000 fine (Wyo. Stat. Ann. § 6-5-107).

(4) Assault/Battery: Varies by degree, up to 7 years and/or $7,000 for felony cases (Wyo. Stat. Ann. § 6-2-502).

(d) Civil Liability: In addition to criminal penalties, healthcare providers shall be liable for civil actions brought by the minor’s legal guardian for damages, including emotional distress, medical costs, and punitive damages.

Section 6. Enforcement

(a) The Wyoming Department of Health shall investigate alleged prospective violations of Section 3, and the Wyoming Attorney General shall oversee prosecutions and civil actions under Section 4.

(b) Citizens may report suspected violations to the Wyoming Department of Health or Attorney General’s office, which shall maintain a confidential reporting mechanism.

Note: Wyoming’s SF 99 (2023) bans gender-affirming care for minors, with penalties for providers. This bill aligns but adds retrospective prosecution, potentially facing challenges under Wyoming’s statute of limitations (Wyo. Stat. Ann. § 6-1-303).