Department of Public Health and Environment Regulation of Abortion Clinics

Second Regular Session Seventy-fifth General Assembly STATE OF COLORADO INTRODUCED HOUSE BILL 26-1243 LLS NO. 26-0666.01 Eden Rolland x2373 HOUSE SPONSORSHIP Bottoms, SENATE SPONSORSHIP (None), House Committees Senate Committees State, Civic, Military, & Veterans Affairs A BILL FOR AN ACT CONCERNING THE REGULATION OF MEDICAL FACILITIES THAT PERFORM INDUCED ABORTIONS AFTER THE FIRST TRIMESTER OF PREGNANCY.

Bill Summary (Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://leg.colorado.gov.) The bill requires the department of public health and environment (department) to annually license, and to establish and enforce standards for the operation of, facilities that are not currently required to be licensed by the department and that perform medical or surgical induced abortions during the second or third trimester of pregnancy. Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.

Capital letters or bold & italic numbers indicate new material to be added to existing law. Dashes through the words or numbers indicate deletions from existing law.

Be it enacted by the General Assembly of the State of Colorado: SECTION 1. Legislative declaration. (1) The general assembly finds that:

(a) Second- and third-trimester abortion clinics are not currently regulated by the Colorado department of public health and environment, also referred to as "CDPHE";

(b) CDPHE is authorized to license, regulate, and inspect a wide spectrum of health-care facilities to ensure public health and safety, including freestanding emergency departments, critical access hospitals, psychiatric hospitals, community clinics, rehabilitation hospitals, convalescent centers, facilities for persons with intellectual and developmental disabilities, nursing care facilities, hospice care, assisted living residences, dialysis treatment clinics, ambulatory surgical centers, birthing centers, and home care agencies;

(c) Gynecologic dilation and curettage, known as a "D&C", and second- and third-trimester obstetric D&C, dilation and evacuation, dilation and extraction, and inductions of labor are all normally performed in facilities regulated by CDPHE. The exception to this protocol is when these same procedures are used during an induced abortion at abortion clinics in the second and third trimester of a pregnancy.

(d) Birthing centers, which are licensed, regulated, and inspected by CDPHE, are prohibited from inducing labor because of the associated risks, but second- and third-trimester abortion clinics routinely use labor-inducing drugs without any CDPHE oversight;

(e) Second- and third-trimester abortion procedures are associated with significant risk. There is a 10% risk that a complication will arise during a second-trimester abortion, including cervical laceration, hemorrhage, uterine atony, anesthesia complications, uterine perforation, disseminated intravascular coagulation, and retained products of conception, and more than a 1.5% risk that a severe complication will arise, including hospitalization, transfusion, or further surgical intervention. The risk from instrument-assisted third-trimester dilation and extraction abortions is substantial. Blood loss increases by 7% for each additional week of gestational age.

(f) The risk of dying from an abortion increases 38% for each week of gestation after 8 weeks. In the early second trimester, the risk of dying from an induced abortion is twice the risk of dying from natural childbirth, and it is greater than the risk of dying from procedures performed at ambulatory surgical centers in the United States and Canada.

Birthing centers and ambulatory surgical centers are both regulated by CDPHE.

(g) Within the past year, Colorado became aware of at least one maternal death directly attributable to a complication of a second-trimester abortion, underscoring the seriousness of these risks and the urgent need for oversight; and

(h) The Colorado Maternal Mortality Review Committee, also referred to as the "MMRC", recommends strategies to achieve equity in maternal health outcomes and ways to reduce the incidence of preventable maternal mortality and morbidity. Pregnancy-associated mortality abortion-associated mortality and abortion-related maternal mortality. The MMRC recommends the use of evidence-based patient safety bundles, evidence-based screening tools, and improved coordination of care as key and pregnancy-related maternal mortality include elements to reduce maternal mortality. It is difficult to ensure implementation of the MMRC recommendations without a licensing, regulation, and inspection process for second- and third-trimester abortion clinics.

(2) Therefore, the general assembly declares that unregulated second- and third-trimester abortion clinics place Colorado women's lives in jeopardy and should be regulated by CDPHE.

SECTION 2. In Colorado Revised Statutes, 25-1.5-103, amend (1)(a)(I)(A); and add (2)(e) as follows: 25-1.5-103. Health facilities - powers and duties of department - rules - limitations on rules - definitions - repeal.

(1) The department has, in addition to all other powers and duties imposed upon it by law, the powers and duties provided in this section as follows:

(a) (I) (A) To annually license and to establish and enforce standards for the operation of general hospitals, hospital units as defined in section 25-3-101 (2), freestanding emergency departments as defined in section 25-1.5-114, critical access hospitals as defined in section 25-1.5-114.5, psychiatric hospitals, community clinics, rehabilitation hospitals, convalescent centers, facilities for persons with intellectual and developmental disabilities, nursing care facilities, hospice care, assisted living residences, dialysis treatment clinics, ambulatory surgical centers, birthing centers, SECOND- AND THIRD-TRIMESTER ABORTION CLINICS, home care agencies, and other facilities of a like nature, except those wholly owned and operated by a governmental unit or agency.

(2) As used in this section, unless the context otherwise requires:

(e) "SECOND- AND THIRD-TRIMESTER ABORTION CLINIC" MEANS A FACILITY THAT PERFORMS MEDICAL OR SURGICAL INDUCED ABORTIONS AFTER THE FIRST TRIMESTER OF PREGNANCY AND THAT IS NOT OTHERWISE PART OF ANOTHER TYPE OF FACILITY REQUIRED TO BE LICENSED BY THE DEPARTMENT PURSUANT TO SUBSECTION (1)(a)(I)(A) OF THIS SECTION.

SECTION 3. Act subject to petition - effective date. This act takes effect at 12:01 a.m. on the day following the expiration of the ninety-day period after final adjournment of the general assembly (August 12, 2026, if adjournment sine die is on May 13, 2026); except that, if a referendum petition is filed pursuant to section 1 (3) of article V of the state constitution against this act or an item, section, or part of this act within such period, then the act, item, section, or part will not take effect unless approved by the people at the general election to be held in November 2026 and, in such case, will take effect on the date of the official declaration of the vote thereon by the governor.