Arizona

House Bill 2564 (2001)

Health Care Providers Rights of Conscience

Note: As of February, 2001 the bill was "held in committees."

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

Section 1. Title 41, chapter 9, Arizona Revised Statutes, is amended by adding article 10, to read:

ARTICLE 10
HEALTH CARE PROVIDERS RIGHTS OF CONSCIENCE

41-1494
Definitions

In this article, unless the context otherwise requires:

1. "Health care institution" means any public or private organization, corporation, partnership, sole proprietorship, association, agency, network, joint venture or other legal entity that is involved in providing health care services, including hospitals, clinics, medical centers, ambulatory surgical centers, private physician's offices, pharmacies, nursing homes, university medical schools and nursing schools, medical training facilities or other institutions or locations in which health care services are provided to any person.

2. "Health care payer" means any entity or financing organization that pays for or arranges for the payment of any health care service or product used in the provision of the health care service, including health maintenance organizations, insurance companies, management services organizations and employers.

3. "Health care provider" means any individual who may be asked to participate, directly or indirectly, in any way in a health care service, including a physician, a physician's assistant, a nurse, a nurses' aide, a medical assistant, a hospital employee, a clinic employee, a nursing home employee, a pharmacist, a pharmacy employee, a medical or nursing school faculty member, student or employee, a chaplain, a counsellor, a social worker, a volunteer or any professional or paraprofessional or any other person who furnishes, or assists in the furnishing of, health care services.

4. "Health care service" means the direct or indirect provision of, or assisting with, any phase of patient medical care, treatment or procedure, whether before or after the fact, including any of the following:

(a) patient referrals.

(b) patient counselling.

(c) patient therapy.

(d) patient testing.

(e) patient diagnosis or prognosis.

(f) research.

(g) instruction.

(h) the prescription or administration of any device, drug or medication or any combination of drugs or medications.

(i) performing surgery.

(j) providing any other care or treatment rendered by health care providers or health care institutions and intended for the patient's physical, mental, emotional or spiritual well-being.

5. "Religious, moral, philosophical or ethical convictions" means the religious, moral, philosophical or ethical principles sincerely believed by an individual and the policies adopted by the governing body of a health care institution or health care payer that are based on sincerely held religious, moral, philosophical or ethical principles.

41-1494.01
Rights of conscience of health care providers

A. A health care provider has the right not to counsel, advise, pay for, provide, perform, assist or participate, directly or indirectly, in performing any health care service that violates the health care provider's religious, moral, philosophical or ethical convictions. A health care provider shall not be required to counsel, advise, pay for, provide, perform, assist or participate, directly or indirectly, in providing any health care service that violates the health care provider's religious, moral, philosophical or ethical convictions.

B. A health care provider shall not be civilly, criminally or administratively liable for any refusal to counsel, advise, pay for, provide, assist or participate, directly or indirectly, in providing or performing any health care service that violates the health care provider's religious or moral conviction if either:

1. Before the request or assignment, the health care provider notified the person making the request or assignment of the health care provider's general refusal and, if asked, certified that general refusal in writing.

2. The health care provider notified the person making The request or assignment of the health care provider's refusal within twenty-four hours after being asked or assigned.

C. It is unlawful for any person, health care provider, health care institution, public or private institution, public official or national certifying board that certifies competency in medical specialties to discriminate against any health care provider in any manner based on the health care provider's refusal to participate in a health care service. For purposes of this subsection, "discrimination" includes termination, transfer, refusal of staff privileges at a health care institution, refusal of board certification, administrative action, demotion, loss of career specialty, reassignment to a different shift, reduction of wages or benefits, refusal to award any grant, contract or other program, refusal to provide standard residency training opportunities or any other penalty or disciplinary or retaliatory action.

D. Within thirty days after the effective date of this article, all health care institutions shall post the following notice in a location that is conspicuous to health care providers, and shall include the notice in any health care institution policy manuals:

1. State law permits any health care provider to refuse to participate in any type of health care service based on the health care provider's religious belief, or moral, ethical or philosophical conviction.

2. A health care provider shall not be civilly, criminally or administratively liable for any refusal to counsel, advise, pay for, provide, assist or participate, directly or indirectly, in providing or performing any health care service that violates the health care provider's religious or moral conviction if either:

(a) Before the request or assignment, the health care provider notified the person making the request or assignment of the health care provider's general refusal and, if asked, certified that general refusal in writing.

(b) The health care provider notified the person making the request or assignment of the health care provider's refusal within twenty-four hours after being asked or assigned.

3. In accord with the Health Care Providers Rights of Conscience Act, title 41, chapter 9, article 10, Arizona Revised Statutes, it is unlawful for any individual or institution to discriminate against, discipline or take any other retaliatory action against any health care provider that exercises the health care provider's right to refuse to participate in any health care service. State law provides specific civil remedies for the violation of the Health Care Providers Rights of Conscience Act, title 41, chapter 9, article 10, Arizona Revised Statutes.

4. "Health care provider" as defined in state law means any individual who may be asked to participate, directly or indirectly, in any way in a health care service, including a physician, a physician's assistant, a nurse, a nurses' aide, a medical assistant, a hospital employee, a clinic employee, a nursing home employee, a pharmacist, a pharmacy employee, a medical or nursing school faculty member, student or employee, a chaplain, a counsellor, a social worker, a volunteer or any professional or paraprofessional or any other person who furnishes, or assists in the furnishing of, health care services.

E. If a health care institution fails to post the notice prescribed in subsection d, the department of health services shall impose on the health care institution a civil penalty of not less than _________ dollars per day.

41-1494.02
Rights of conscience of health care institutions

A. A health care institution has the right not to counsel, advise, pay for, provide, perform, assist or participate, directly or indirectly, in performing any health care service that violates its religious, moral, philosophical or ethical convictions. A health care institution shall not be required to counsel, advise, pay for, provide, perform, assist or participate, directly or indirectly, in providing any health care service, including admitting with the purpose of providing health care services, that violates the policies adopted by the governing body of the health care institution that are based on religious, moral, philosophical or ethical convictions.

B. A health care institution shall not be civilly, criminally or administratively liable to any person for such refusal if either:

1. The institution posted notice of its refusal policy in plain sight in any admission area of the institution before the request or assignment.

2. The institution notified the person requesting the health care service of its refusal within twenty-four hours of the request.

C. It is unlawful for any person, public or private institution or public official to discriminate against any person, association or corporation attempting to establish a new health care institution or operating an existing health care institution, in any manner, including denial, deprivation or disqualification in licensing, granting of authorizations, aid, assistance, benefits, medical Staff or any other privileges and granting authorization to expand, improve, merge or establish any health care institution, by reason of the refusal of the person, association or corporation planning, proposing or operating a health care institution to permit or perform any particular form of health care service that violates the health care institution's conscience as documented in its existing or proposed ethical guidelines, mission statement, constitution, bylaws, articles of incorporation, regulations or other governing documents.

D. It is unlawful for any public official, agency, institution or entity to deny any form of aid, assistance, grant or benefit or in any other manner to coerce, disqualify or discriminate against any person, association or corporation attempting to establish a new health care institution or operating an existing health care institution that otherwise would be entitled to the aid, assistance, grant or benefit because the existing or proposed health care institution refuses to perform, assist, counsel, suggest, recommend, refer or participate in any way in any form of health care service contrary to the health care institution's conscience as documented in its existing or proposed ethical guidelines, mission statement, constitution, bylaws, articles of incorporation, regulations or other governing documents.

41-1494.03
Rights of conscience of health care payers

A. A health care payer has the right to refuse to pay or arrange for the payment of any health care service or product that violates its policies adopted by its governing body that are based on religious, moral, philosophical or ethical convictions.

B. No health care payer and no person, association or corporation that owns, operates, supervises or manages a health care payer shall be civilly or criminally liable to any person, estate or public entity by reason of refusal of the health care payer to pay for or arrange for the payment of any particular form of health care service that violates the health care payer's conscience as documented in its ethical guidelines, mission statement, constitution, bylaws, articles of incorporation, regulations or other governing documents.

C. It is unlawful for any person, public or private institution or public official to discriminate against any person, association or corporation attempting to establish a new health care payer or operating an existing health care payer, in any manner, including denial, deprivation or disqualification in licensing, granting of authorizations, aid, assistance, benefits or any other privileges and granting authorization to expand, improve, merge or create any health care payer, because the person, association or corporation planning, proposing or operating a health care payer refuses to pay for or arrange for the payment of any particular form of health care service that violates the health care payer's conscience as documented in the existing or proposed ethical guidelines, mission statement, constitution, bylaws, articles of incorporation, regulations or other governing documents.

D. It is unlawful for any public official, agency, institution, or entity to deny any form of aid, assistance, grant or benefit or in any other manner to coerce, disqualify or discriminate against any person, association or corporation attempting to establish a new health care payer or operating an existing health care payer that otherwise would be entitled to the aid, assistance, grant or benefit because the existing or proposed health care payer refuses to pay for, arrange for the payment of or participate in any way in any form of health care service contrary to the health care payer's conscience as documented in its existing or proposed ethical guidelines, mission statement, constitution, bylaws, articles of incorporation, regulations or other governing documents.

41-1494.04
Civil remedies

A. A civil action for damages or injunctive relief, or both, may be brought for a violation of this article. It is not a defense to any claim arising out of a violation of this article that the violation was necessary to prevent additional burden or expense on any other health care provider, health care institution, individual or patient.

B. Any individual, association, corporation, entity or health care institution injured by any public or private individual, association, agency, entity or corporation by reason of any conduct prohibited by this article may commence a civil action. On finding a violation of this article, the aggrieved party is entitled to recover three times the actual damages, including pain and suffering, sustained by the individual, association, corporation, entity or health care institution, the costs of the action and reasonable attorney fees, except that in no case shall recovery be less than five thousand dollars for each violation in addition to costs of the action and reasonable attorney fees. These damage remedies are cumulative and are not exclusive of other remedies afforded under any other state or federal law.

C. The court in a civil action under this article may award injunctive relief, including ordering reinstatement of a health care provider to the health care provider's prior job position.

Sec. 2.
Purpose

A. It is the public policy of this state to respect and protect the fundamental rights of conscience of all individuals who are involved in providing health care services.

B. Without a comprehensive civil rights act for health care providers, religious beliefs and rights of conscience may be violated in various ways, such as harassment, demotion, salary reduction, transfer, termination, loss of staffing privileges, denial of aid or benefits and refusal to license or certify.

C. It is the purpose of this act to protect as a basic civil right of all individuals and institutions to refuse to counsel, advise, pay for, provide, perform, assist or participate, directly or indirectly, in providing or performing health care services that violate the individual's religious, moral, philosophical or ethical convictions. These health care services may include abortion, artificial insemination, assisted reproduction, artificial birth control, cloning, human stem cell and fetal experimentation, withdrawal of nutrition and hydration, physician-assisted suicide and euthanasia.

D. Accordingly, it is the purpose of this act to prohibit all forms of discrimination, disqualification, coercion, disability or liability on individuals or institutions that refuse to perform any health care service based on religious, moral, philosophical or ethical convictions.

Sec. 3
Severability

If a provision of this act or its application to any person or circumstance is held invalid, the invalidity does not affect other provisions or applications of the act that can be given effect without the invalid provision or application, and to this end the provisions of this act are severable.