109th CONGRESS
2d Session
S. 3945
To provide for the provision by hospitals of emergency contraceptives
to women, and post-exposure prophylaxis for sexually transmitted disease
to individuals, who are survivors of sexual assault.
IN THE SENATE OF THE UNITED STATES
September 26, 2006
Mrs. CLINTON (for herself, Mrs. MURRAY, Mr. LAUTENBERG, Mrs. BOXER, Mr.
MENENDEZ, Ms. CANTWELL, Mr. KENNEDY, Mr. INOUYE, Mr. KERRY, Mr. JEFFORDS,
and Mr. CHAFEE) introduced the following bill; which was read twice and
referred to the Committee on Health, Education, Labor, and Pensions
A BILL
To provide for the provision by hospitals of emergency contraceptives
to women, and post-exposure prophylaxis for sexually transmitted disease
to individuals, who are survivors of sexual assault.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the `Compassionate Assistance for Rape Emergencies
Act'.
SEC. 2. FINDINGS.
Congress finds the following:
(1) It is estimated that 25,000 to 32,000 women become pregnant each year
as a result of rape or incest. An estimated 22,000 of these pregnancies
could be prevented if rape or incest survivors had timely access to emergency
contraception.
(2) A 1996 study of pregnancies resulting from rape or incest (published
in the American Journal of Obstetrics and Gynecology) found that 50 percent
of the pregnancies described in paragraph (1) ended in abortion.
(3) Surveys have shown that many hospitals do not routinely provide emergency
contraception to women seeking treatment after being sexually assaulted.
(4) The risk of pregnancy after sexual assault has been estimated to be
4.7 percent in survivors who were not protected by some form of contraception
at the time of the attack.
(5) The Food and Drug Administration has declared emergency contraception
to be safe and effective in preventing unintended pregnancy, reducing
the risk by as much as 89 percent if taken within days of unprotected
intercourse and up to 95 percent if taken in the first 24 hours after
unprotected intercourse.
(6) Medical research strongly indicates that the sooner emergency contraception
is administered, the greater the likelihood of preventing unintended pregnancy.
(7) In light of the safety and effectiveness of emergency contraceptive
pills, both the American Medical Association and the American College
of Obstetricians and Gynecologists have endorsed more widespread availability
of such pills.
(8) The American College of Emergency Physicians and the American College
of Obstetricians and Gynecologists agree that offering emergency contraception
to female patients after a sexual assault should be considered part of
the standard of care.
(9) Approximately 30 percent of United States women of reproductive age
are unaware of the availability of emergency contraception.
(10) New data from a survey of women having abortions estimates that 51,000
abortions were prevented by use of emergency contraception in 2000 and
that increased use of emergency contraception accounted for 43 percent
of the decrease in total abortions between 1994 and 2000.
(11) It is essential that all hospitals that provide emergency medical
treatment provide emergency contraception as a treatment option to any
woman who has been sexually assaulted, so that she may prevent an unintended
pregnancy.
(12) Victims of sexual assault are at increased risk of contracting sexually
transmitted diseases.
(13) Some sexually transmitted infections cannot be reliably cured if
treatment is delayed, and may result in high morbidity and mortality.
HIV has killed over 520,000 individuals in the United States, and the
Centers for Disease Control and Prevention currently estimates that over
1,000,000 individuals in the United States are infected with the virus.
Even modern drug treatment has failed to cure infected individuals. Nearly
80,000 individuals in the United States are infected with hepatitis B
each year, with some individuals unable to fully recover. An estimated
1,250,000 individuals in the United States remain chronically infected
with the hepatitis B virus and at present, 1 in 5 of those infected individuals
may expect to die of liver failure.
(14) It is possible to prevent some sexually transmitted diseases by treating
an exposed individual promptly. The use of post-exposure prophylaxis using
antiretroviral drugs has been demonstrated to effectively prevent the
establishment of HIV infection. Hepatitis B infection may also be eliminated
if an exposed individual receives prompt treatment.
(15) The Centers for Disease Control and Prevention has recommended risk
evaluation and appropriate application of post-exposure treatment for
victims of sexual assault. For such individuals, immediate treatment is
the only means to prevent a life-threatening infection.
(16) It is essential that all hospitals that provide emergency medical
treatment provide assessment and treatment of sexually transmitted infections
to minimize the harm to victims of sexual assault.
SEC. 3. DEFINITIONS.
(1) EMERGENCY CONTRACEPTION- The term `emergency contraception' means
a drug, drug regimen, or device that is--
(A) approved by the Food and Drug Administration to prevent pregnancy;
and
(B) is used postcoitally.
(2) HOSPITAL- The term `hospital' has the meaning given such term in title
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), including the
meaning applicable in such title for purposes of making payments for emergency
services to hospitals that do not have agreements in effect under such
title. Such term includes a health care facility that is located within,
or that enters into a contract with, a correctional institution or a post-secondary
educational institution.
(3) LICENSED MEDICAL PROFESSIONAL- The term `licensed medical professional'
means a doctor of medicine, doctor of osteopathy, registered nurse, physician
assistant, or any other health care professional determined to be appropriate
by the Secretary.
(4) SECRETARY- The term `Secretary' means the Secretary of Health and
Human Services.
(A) IN GENERAL- The term `sexual assault' means a sexual act (as defined
in subparagraphs (A) through (C) of section 2246(2) of title 18, United
States Code) where the victim involved does not consent or lacks the
capacity to consent.
(B) APPLICATION OF PROVISIONS- The definition in subparagraph (A) shall--
(i) in the case of section 2, apply to males and females, as appropriate;
(ii) in the case of section 4, apply only to females; and
(iii) in the case of section 5, apply to all individuals.
SEC. 4. SURVIVORS OF SEXUAL ASSAULT; PROVISION BY HOSPITALS OF EMERGENCY
CONTRACEPTIVES WITHOUT CHARGE.
(a) In General- Federal funds may not be provided to a hospital under any
health-related program, unless the hospital meets the conditions specified
in subsection (b) in the case of--
(1) any woman who arrives at the hospital and states that she is a victim
of sexual assault, or is accompanied by someone who states she is a victim
of sexual assault; and
(2) any woman who arrives at the hospital whom hospital personnel have
reason to believe is a victim of sexual assault.
(b) Assistance for Victims- The conditions specified in this subsection
regarding a hospital and a woman described in subsection (a) are as follows:
(1) INFORMATION- The hospital promptly provides the woman with medically
and factually accurate and unbiased written and oral information about
emergency contraception, including information explaining that--
(A) emergency contraception has been approved by the Food and Drug Administration
as a safe and effective way to prevent pregnancy after unprotected intercourse
or contraceptive failure if taken in a timely manner, and is more effective
the sooner it is taken; and
(B) emergency contraception does not cause an abortion and cannot interrupt
an established pregnancy.
(2) EMERGENCY CONTRACEPTION- The hospital promptly offers emergency contraception
to the woman, and promptly provides such contraception to her at the hospital
on her request.
(3) CONDITIONS FOR INFORMATION- The information provided pursuant to paragraph
(1) is in clear and concise language, is readily comprehensible, and meets
such conditions regarding the provision of the information in languages
other than English as the Secretary may establish.
(4) PROVISION DESPITE INABILITY TO PAY- The services described in paragraphs
(1) through (3) are not denied because of the inability of the woman to
pay for the services.
SEC. 5. PREVENTION OF [Struck out->][ SEXUALLY
TRANSMITTED ][<-Struck out] DISEASE.
(a) In General- Federal funds may not be provided to a hospital under any
health-related program, unless the hospital provides risk assessment, counseling,
and treatment as required under this section to a survivor of sexual assault
described in subsection (b).
(b) Survivors of Sexual Assault- An individual is a survivor of a sexual
assault described in this subsection if the individual--
(1) arrives at the hospital and states that the individual is a victim
of sexual assault, or is accompanied to the hospital by another individual
who declares that the first individual is a victim of sexual assault;
or
(2) arrives at the hospital and hospital personnel have reason to believe
the individual is a victim of sexual assault.
(c) Requirement for Risk Assessment, Counseling, and Treatment- The following
shall apply with respect to a hospital described in subsection (a):
(1) RISK ASSESSMENT- A hospital shall promptly provide a survivor of a
sexual assault with an assessment of the individual's risk of contracting
sexually transmitted infections described in paragraph (2)(A), which assessment
shall be conducted by a licensed medical professional and be based upon--
(A) available information regarding the assault as well as the subsequent
findings from medical examination and any tests that may be conducted;
and
(B) established standards of risk assessment which shall include consideration
of any recommendations established by the Centers for Disease Control
and Prevention, and may also incorporate consideration of findings of
peer-reviewed clinical studies and appropriate research utilizing in
vitro and non-human primate models of infection.
(2) COUNSELING- A hospital shall provide a survivor of a sexual assault
with advice, provided by a licensed medical professional, concerning--
(A) significantly prevalent sexually transmitted infections for which
effective post-exposure prophylaxis exists, and for which the deferral
of treatment would either significantly reduce treatment efficacy or
pose substantial risk to the individual's health; and
(B) the requirement that prophylactic treatment for infections described
in subparagraph (A) shall be provided to the individual upon request,
regardless of the ability of the individual to pay for such treatment.
(3) TREATMENT- A hospital shall provide a survivor of a sexual assault,
upon request, with prophylactic treatment for infections described in
paragraph (2)(A).
(4) ABILITY TO PAY- The services described in paragraphs (1) through (3)
shall not be denied because of the inability of the individual involved
to pay for the services.
(5) LANGUAGE- Any information provided pursuant to this subsection shall
be clear and concise, readily comprehensible, and meet such conditions
regarding the provision of the information in languages other than English
as the Secretary may establish.
(d) Rule of Construction- Nothing in this section shall be construed to--
(1) require that a hospital provide prophylactic treatment for a victim
of sexual assault when risk assessment (according to recommendations established
by the Centers for Disease Control and Prevention) clearly recommends
against the application of post-exposure prophylaxis;
(2) prohibit a hospital from seeking reimbursement for the cost of services
provided under this section to the extent that health insurance may provide
reimbursement for such services; and
(3) establish a requirement that any victim of sexual assault submit to
diagnostic testing for the presence of any infectious disease.
SEC. 6. AGENCY CRITERIA.
Not later than 30 days prior to the expiration of the period described in
section 7, the Secretary shall publish in the Federal Register criteria
for meeting the conditions described in sections 4 and 5.
SEC. 7. EFFECTIVE DATE.
This Act takes effect on the expiration of the 180-day period beginning
on the date of the enactment of this Act.
END
