HB 1706-FN - AS INTRODUCED
2024 SESSION
24-2602
05/08
HOUSE BILL 1706-FN
AN ACT relative to notice required prior to circumcision procedure.
SPONSORS: Rep. Phillips, Rock. 7; Rep. Santonastaso, Ches. 18; Rep. Osborne, Rock. 2; Rep. Yokela, Rock. 32; Rep. Cushman, Hills. 28; Rep. Soti, Rock. 35; Rep. Potenza, Straf. 19; Rep. Read, Rock. 10; Rep. Wheeler, Hills. 33
COMMITTEE: Health, Human Services and Elderly Affairs
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ANALYSIS
This bill requires health care providers to provide parents with specific information prior to performing a circumcision procedure.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
24-2602
05/08
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Four
AN ACT relative to notice required prior to circumcision procedure.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Short Title. This act shall be known as the "Circumcision Transparency Act (CTA)".
2 New Section; Protection for Maternity and Infancy; Notice Required Prior to Circumcision Procedure. Amend RSA 132 by inserting after section 10-f the following new section:
132:10-g Notice Required Prior to Circumcision Procedure.
I. In this section:
(a) “Health care provider” is defined as a hospital, health care facility, physician, resident physician, physician assistant, midwife, or registered nurse, practicing in the state of New Hampshire.
(b) “Health insurance provider” is defined as any entity, private or public, that offers insurance coverage for health care services to residents of the state of New Hampshire. This includes publicly funded programs such as Medicaid.
(c) “Informed consent form” is a form approved by the department of health and human services and provided by health care providers to parents, that adequately describes the potential benefits and inherent risks and disadvantages of routine non-therapeutic circumcision on a newborn or child, as well as the option of non-treatment and the availability of non-surgical tissue-sparing prophylaxis and treatments. Such written consent form shall only be valid if executed pursuant to the provisions of this section.
(d) “Parents” refers to a parent, parents, or legal guardian(s) of a child.
(e) “Newborn child” or “child”, is a person who is less than 18 years of age.
(f) “Solicitation” or “solicit” means the act of a health care provider asking, questioning, or approaching one or more parents about circumcision, or proffering a circumcision consent form for an otherwise healthy infant or child, unless an inquiry is first made by the parent or parents.
(g) “Circumcision” refers to the surgical removal of the foreskin from the penis.
(h) “Circumcision device” means a restraining board (e.g., Circumstraint), Gomco Clamp, Mogen Clamp, Plastibell or any other device used for the intended purpose of facilitating the surgical excision of the penile foreskin from the remainder of the penis.
(i) “Intact care guide” means printed information approved by department designed to inform parents on proper care of the intact (uncircumcised) penis.
(j) "Department" means the department of health and human services.
II.(a) No health care provider shall circumcise any newborn child without first furnishing to the parents a circumcision-specific and comprehensive informed consent form compliant with this section. Generic surgical consent forms shall not be permitted or used.
(b) Health care providers shall acknowledge that the parents:
(1) Have been informed in writing of the potential benefits and inherent risks and disadvantages of routine non-therapeutic circumcision, as well as the option of non-treatment and the availability of non-surgical tissue-sparing prophylaxis and treatments if necessary; and
(2) Have seen the circumcision devices to be used and the parents still wish to proceed with the circumcision of the child.
(c) Only after the above have been acknowledged may the child’s parents sign, date and return to the health care provider the informed consent form. The form shall provide for 2 parental signatures. When only one individual is acknowledged or listed as the child’s parent, one signature will suffice. When 2 individuals are acknowledged or listed as the child’s parents, both parents shall sign the consent form. If one of the 2 parents is not present to sign, refuses to sign, objects to, or otherwise makes known their objections to the circumcision of the child, a circumcision shall not proceed. In this event, the form shall be marked by the health care provider as "refused," with the date/time of refusal noted and charted as such in the medical record. This act shall supersede prior custody arrangements and parenting plans regarding medical care for the child, even if such arrangements are court ordered or stipulated.
III. No health care provider shall solicit any parent for a circumcision procedure, use pressure or coercion, suggest non-medical reasons as a benefit, or use undue influence to obtain the informed consent of parents pursuant to this section.
IV. The provisions of this section shall not apply to persons or health care providers performing an official religious circumcision in a non-medical facility.
V. The department shall institute appropriate disciplinary procedures for violations of this section by health care providers, which may include referral to the appropriate occupational licensing board and monetary penalties for medical facilities licensing by the department.
VI. Health care providers shall maintain a copy of the consent form for a minimum of 25 years, and make it available at no cost to the subject of the circumcision upon request.
VII. Since it is a normal physiological condition for boys to have a non-retractable foreskin prior to puberty and often into late teenage years, health care providers shall not use a diagnosis of phimosis to order or solicit a circumcision if the condition is not an immediate or significant threat to the child’s health or physical, sexual or emotional well-being, or if the condition can be conservatively treated without circumcision.
VIII. If parents choose a circumcision procedure for their son, they shall not be automatically compelled to consent to donate their son’s foreskin tissue. Consent to tissue donation, if sought by a health care provider, shall appear as a clearly defined opt-in, or opt out choice on the form.
IX. Parents who do not circumcise their child shall receive an intact care guide; a brochure written to educate the parents on the care of the intact, uncircumcised penis.
X. The information provided on the informed consent form shall include the following:
(a) Circumcision is a medically unnecessary cosmetic procedure (printed in bold 12 point type at minimum). It is the surgical removal of the foreskin from the penis. The foreskin comprises up to 50 percent of the skin on the penis. Circumcision is extremely painful and traumatic to children, causes some infants to go into shock, and can result in behavioral and neurological changes. Anesthetic/analgesia, if provided, does not fully prevent circumcision pain during and after the procedure.
(b) On the average adult male, the foreskin comprises about 15 square inches of very sexually sensitive tissue which protects the head of the penis, enhances sexual pleasure and facilitates intercourse.
(c) Circumcision is associated with between 20 and 47 known complications, including heavy bleeding, infection, disfigurement, scarring, meatal stenosis, skin bridges, loss of sexual function, poor cosmetic appearance, follow-up correction surgery, and in rare cases, death. The long-term impact of newborn circumcision on the physical, sexual, emotional, and psychological health, self-esteem and well-being of boys and adult men has never been followed is only now being explored and publicized in response to increasing complaints from circumcision sufferers and those pursuing foreskin restoration.
(d) Your son may want an intact penis, and a decision to have a circumcision denies him his bodily integrity and autonomy which he may resent when he matures.
(e) No national medical organization in the United States or the world recommends circumcision. All international medical organizations outside of the United States actively discourage circumcision of newborns and children and warn of long-term harmful sexual and psychological consequences of circumcision.
(f) The natural intact penis is easy to keep clean and requires no special care.
(g) There are no proven medical benefits following newborn circumcision, only speculated potential benefits. Any potential benefits would be realized by very few boys, varying from 1 in 100 to 1 in 100,000 circumcised boys, while various studies have evaluated the risks of surgical complications from circumcision ranging from 0.06 to 55 percent depending on the definition of the term “complication”. An as yet under-researched percentage of boys and men suffer adverse consequences that manifest later in life. The most common complication of newborn circumcision is meatal stenosis (narrowing of the urinary opening) which is estimated to be as high as 20 percent, and requires meatotomy (surgical reopening). Studies of non-therapeutic circumcision in infancy or childhood did not appear to provide protection against HIV or other STI’s.
(h) The actual medical need for circumcision in adults is as low as 6 in 100,000.
(i) A signature on this form acknowledges that the signer has been shown an infant circumstraint restraining board and the circumcision crushing clamp if used on the child.
(j) The non-treatment option involves no circumcision. This option entails no risks when all caregivers avoid improper foreskin interventions, and are educated about normal development, proper care and hygiene. Non-surgical options for alternative prophylaxis and treatment of potential problems are those that are tissue-sparing.
(k) Receiving this consent form does not mean that circumcision is recommended. Parents may freely choose not to circumcise their son by withholding signature and returning this form unsigned.
XI. The consent form shall include complete source notes for the statistical information provided pursuant to subparagraphs X(a) – (j). All print on the consent form shall be 10 point type or larger, with a minimum of single line spacing, except for subparagraph X(a). All forms shall be original prints. Photocopies of forms shall not be used. If electronic signatures are taken, the information pursuant to paragraph X shall be provided to parents in a printed paper format. Consent forms shall be provided in multilingual versions for non-English speaking parents.
XII. Health care providers shall submit copies of their compliant circumcision consent forms and intact care guides to the commissioner of the department within 90 days of enactment of this legislation for approval by the department.
XIII. Prior to approving circumcision consent forms and intact care guides, the department shall provide copies of such forms at no cost to registered non-profit advocacy organizations that educate about circumcision harm and children’s rights to bodily integrity and autonomy, and the department shall consider input from such organizations prior to approval.
3 Effective Date. This act shall take effect 60 days after its passage.
24-2602
Revised 1/23/24
HB 1706-FN- FISCAL NOTE
AS INTRODUCED
AN ACT relative to notice required prior to circumcision procedure.
FISCAL IMPACT: [ X ] State [ ] County [ ] Local [ ] None
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Estimated State Impact - Increase / (Decrease) | ||||||
| FY 2024 | FY 2025 | FY 2026 | FY 2027 | ||
Revenue | $0 | $0 | $0 | $0 | ||
Revenue Fund(s) | None | |||||
Expenditures | $0 | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase | ||
Funding Source(s) | General Fund | |||||
Appropriations | $0 | $0 | $0 | $0 | ||
Funding Source(s) | None | |||||
• Does this bill provide sufficient funding to cover estimated expenditures? [X] No • Does this bill authorize new positions to implement this bill? [X] No | ||||||
METHODOLOGY:
This bill requires health care providers to provide parents with specific information prior to performing a circumcision. The bill requires the Department of Health and Human Services to institute disciplinary procedures for violations by health care providers, which may include referral to the appropriate occupational licensing board. The Department would also be required to approve all consent forms and informational materials and provide copies at no cost to non-profit advocacy organizations. The Department predicts an indeterminable increase in state general fund expenditures associated with reviewing and approving an anticipated large number of consent forms and informational materials. The Department did not provide an estimated cost range.
AGENCIES CONTACTED:
Department of Health and Human Services