Louisiana Administrative Code
Title 48 - PUBLIC HEALTH-GENERAL
Part I - General Administration
Subpart 3 - Licensing and Certification
Chapter 44 - Abortion Facilities
Subchapter C - Pre-operative, Intra-operative, and PostOperative Procedures
Section I-4431 - Screening and Pre-Operative Services
Universal Citation: LA Admin Code I-4431
Current through Register Vol. 50, No. 9, September 20, 2024
A. Verification of Pregnancy. The presence of an intrauterine pregnancy shall be verified by the following:
1. urine or serum pregnancy test performed
on-site; and
2. either a detection
of fetal heart tones or ultrasonography.
B. Gestational age shall be estimated by the following methods pre-operatively:
1. first
date of last menstrual period, if known;
2. pelvic examination; and
3. ultrasonography.
C. Laboratory Tests
1. The laboratory tests listed below shall be
performed within 30 days prior to the abortion procedure:
a. hematocrit or hemoglobin determination;
and
b. Rh Factor
status.
2. The results of
the laboratory tests as required in §4331.C.1.a-b shall be documented in the
patient's medical record.
3. The
physician performing the abortion shall document acknowledgement of the results
of the laboratory tests in the patient's medical record prior to the abortion
procedure.
D. Minors
1. No physician shall perform or induce an
abortion upon any pregnant woman who is under the age of 18 years and who is
not emancipated judicially or by marriage unless the physician has received the
following:
a. one of the following documents:
i. a notarized statement, pursuant to
applicable state laws, rules, and regulations, signed by either the mother,
father, legal guardian, or tutor of the minor declaring that the affiant has
been informed that the minor intends to seek an abortion and that the affiant
consents to the abortion; or
ii. a
court order pursuant to applicable state laws, rules, and regulations;
and
b. a signed, dated,
and timed document obtained by the attending physician and/or licensed nurse,
before the administration of any type of anesthesia which indicates if any
person has or has not compelled the female child to undergo an abortion against
her will.
2. All
documentation related to consent and coercion shall be maintained in the
medical record.
E. Ultrasound Requirements. Except in the case of a medical emergency, consent to an abortion of an unborn child at any stage of gestational development is voluntary and informed only if an obstetric ultrasound is performed in accordance with the provisions of this Section and applicable state laws, rules, and regulations.
1. Qualifications to
Perform Ultrasound. The ultrasound shall be performed by the physician who is
to perform the abortion or a qualified person who is the physician's agent. For
purposes of this Section, "qualified person" means a person having documented
evidence that he or she has completed a course in the operation of ultrasound
equipment and is in compliance with any other requirements of law regarding the
operation of ultrasound equipment.
2. Requirements
a. Except as provided in Subparagraph b
below, at least 72 hours prior to the pregnant woman having any part of an
abortion performed or induced, and prior to the administration of any
anesthesia or medication in preparation for the abortion on the pregnant woman,
the physician who is to perform the abortion or a qualified person who is the
physician's agent shall comply with all of the following requirements:
i. perform an obstetric ultrasound on the
pregnant woman, offer to simultaneously display the screen which depicts the
active ultrasound images so that the pregnant woman may view them and make
audible the fetal heartbeat, if present, in a quality consistent with current
medical practice. Nothing in this Section shall be construed to prevent the
pregnant woman from not listening to the sounds detected by the fetal heart
monitor, or from not viewing the images displayed on the ultrasound
screen;
ii. provide a simultaneous
and objectively accurate oral explanation of what the ultrasound is depicting,
in a manner understandable to a layperson, which shall include the presence and
location of the unborn child within the uterus and the number of unborn
children depicted, the dimensions of the unborn child, and the presence of
cardiac activity if present and viewable, along with the opportunity for the
pregnant woman to ask questions;
iii. offer the pregnant woman the option of
requesting an ultrasound photograph or print of her unborn child of a quality
consistent with current standard medical practice that accurately portrays, to
the extent feasible, the body of the unborn child including limbs, if present
and viewable;
iv. from a form that
shall be produced and made available by the department, staff will orally read
the statement on the form to the pregnant woman in the ultrasound examination
room prior to beginning the ultrasound examination, and obtain from the
pregnant woman a copy of a completed, signed, and dated form; and
v. retain copies of the election form and
certification prescribed above. The certification shall be placed in the
medical file of the woman and shall be kept by the outpatient abortion facility
for a period of not less than seven years. If the woman is a minor, the
certification shall be placed in the medical file of the minor and kept for at
least seven years or for five years after the minor reaches the age of
majority, whichever is greater. The woman's medical files shall be kept
confidential as provided by law.
b. If the pregnant woman certifies in writing
that she currently lives 150 miles or more from the nearest licensed outpatient
abortion facility that is willing and able to perform the abortion at the
particular woman's stage of pregnancy, then the physician who is to perform the
abortion or a qualified person who is the physician's agent shall comply with
all of the requirements of
§4431.E.2.a at least 24
hours prior to the woman having any part of an abortion performed or
induced.
c. - e.
Repealed.
3. Options to
view or listen to required medical information shall be in accordance with
applicable state laws, rules, and regulations.
a. A pregnant woman may choose not to
exercise her option to request an ultrasound photograph print.
b. A pregnant woman may choose not to view
the ultrasound images required to be provided to and reviewed with the pregnant
woman.
c. A pregnant woman may
choose not to listen to the sounds detected by the fetal heart monitor required
to be provided to the pregnant woman.
F. Medical Emergencies. Upon a determination by a physician that a medical emergency, as defined pursuant to applicable state law, exists with respect to a pregnant woman, the outpatient abortion facility shall certify in writing the specific medical conditions that constitute the emergency. The certification shall be placed in the medical file of the woman.
G. Information and Informed Consent
1. Oral and Written
Information Provided by Physician or Referring Physician
a. Except as provided in Paragraph b below,
at least 72 hours before the abortion the physician who is to perform the
abortion or the referring physician shall provide informed consent to the
pregnant woman seeking an abortion, pursuant to all laws, rules and regulations
regarding informed consent. The informed consent shall be communicated both
orally and in-person, and in writing, and shall be provided in a private room.
Documentation of all such informed consent provided shall be maintained in the
patient's medical record.
b. If the
woman certifies in writing that she currently lives 150 miles or more from the
nearest licensed outpatient abortion facility that is willing and able to
perform the abortion at the particular woman's stage of pregnancy, then the
physician who is to perform the abortion or the referring physician shall
comply with all of the requirements of
§4431.G.1 at least 24
hours prior to the abortion.
c.
The informed consent shall also contain language explaining the following
information to the pregnant woman seeking an abortion:
i. the option of reviewing and receiving an
oral explanation of an obstetric ultrasound image of the unborn
child;
ii. that the pregnant woman
shall not be required to view or receive an explanation of the obstetric
ultrasound images;
iii. that the
pregnant woman shall not be penalized if she chooses not to view or receive an
explanation of the obstetric ultrasound images;
iv. that the physician shall not be penalized
if the pregnant woman chooses not to view or receive an explanation of the
obstetric ultrasound images; and
v.
inclusion in the patient's printed materials of a comprehensive list, compiled
by the department, of facilities that offer obstetric ultrasounds free of
charge.
2. Oral
Information from a Physician or Qualified Person
a. When an initial contact is made by a
person seeking to schedule an abortion for herself, a minor, or other adult
woman, regardless of the means of contact, the physician who is to perform the
abortion or any qualified person acting on behalf of the physician shall inform
the person of the internet address of the department's abortion alternatives
and informed consent website which includes links to mental health
counseling.
3. Oral
Information Provided by Physician, Referring Physician, or Qualified Person
a. Except as provided in Subparagraph b
below, at least 72 hours before a scheduled abortion the physician who is to
perform the abortion, the referring physician, or a qualified person shall
inform the pregnant woman seeking an abortion, orally and in-person that:
i. medical assistance may be available for
prenatal care, childbirth, and neonatal care and that more detailed information
on the availability of such assistance is contained on the department's website
and printed materials;
ii. a
pamphlet is available that describes the unborn child and contains a directory
of agencies that offer an abortion alternative;
iii. the father of the unborn child is liable
to assist in the support of the child, even if he has offered to pay for the
abortion. In the case of rape this information may be omitted;
iv. the pregnant woman seeking an abortion is
free to withhold or withdraw consent to the abortion at any time before or
during the abortion without affecting her right to future care or treatment and
without loss of any state or federally funded benefits to which she might
otherwise be entitled.
b.
If the woman certifies in writing that she currently lives 150 miles or more
from the nearest licensed outpatient abortion facility that is willing and able
to perform the abortion at the particular woman's stage of pregnancy, then the
physician who is to perform the abortion the referring physician, or a
qualified person shall comply with all of the requirements of
§4431.G.3 at least 24
hours prior to the abortion.
4. Provision of Printed Materials
a. At least 72 hours before the abortion, the
pregnant woman seeking an abortion shall be given a copy of the printed
materials, pursuant to any applicable state laws, rules, and regulations, by
the physician who is to perform the abortion, the referring physician, or a
qualified person. These printed materials shall include any printed materials
necessary for a voluntary and informed consent, pursuant to
R.S.
40:1061.17. However, if the pregnant woman
certifies in writing that she currently lives 150 miles or more from the
nearest licensed outpatient abortion facility that is willing and able to
perform the abortion at the particular woman's stage of pregnancy, she shall be
given a copy of the printed materials at least 24 hours prior to an elective
abortion procedure by the physician who is to perform the abortion or a
qualified person as defined in
R.S.
40:1061.17(B)(4)(c).
i. - NOTE Repealed.
b. At least 72 hours before the abortion, the
pregnant woman or minor female considering an abortion shall be given a copy of
the department's Point of Rescue pamphlet and any other
materials described in
R.S.
40:1061.16 by the physician who is to perform
the abortion or a qualified person as defined in
R.S.
40:1061.17(B)(4)(c), except
in the case of medical emergency defined by applicable state laws. However, if
the pregnant woman or minor female considering an abortion certifies in writing
that she currently lives 150 miles or more from the nearest licensed outpatient
abortion facility that is willing and able to perform the abortion at the
particular woman's stage of pregnancy, she shall be given a copy of these
printed materials at least 72 hours prior to an elective abortion procedure by
the physician who is to perform the abortion or a qualified person as defined
in R.S.
40:1061.17(B)(4)(c), except
in the case of medical emergency defined by applicable state laws.
i. The physician or qualified person shall
provide to the woman, or minor female seeking an abortion, such printed
materials individually and in a private room for the purpose of ensuring that
she has an adequate opportunity to ask questions and discuss her individual
circumstances.
ii. The physician or
qualified person shall obtain the signature of the woman or minor female
seeking an abortion on a form certifying that the printed materials were given
to the woman or minor female.
iii.
In the case of a minor female considering an abortion, if a parent accompanies
the minor female to the appointment, the physician or qualified person shall
provide to the parent copies of the same materials given to the
female.
iv. The signed
certification form shall be kept within the medical record of the woman or
minor female for a period of at least seven years.
c. At least 72 hours before the abortion, the
pregnant woman seeking an abortion shall be given a copy of a printed
informational document including resources, programs and services for pregnant
women who have a diagnosis of fetal genetic abnormality and resources, programs
and services for infants and children born with disabilities. However, if the
pregnant woman certifies in writing that she currently lives 150 miles or more
from the nearest licensed outpatient abortion facility that is willing and able
to perform the abortion at the particular woman's stage of pregnancy, she shall
be given a copy of these printed materials at least 24 hours prior to an
elective abortion procedure by the physician who is to perform abortion or a
qualified person as defined in
R.S.
40:1061.17(B)(4)(c).
d. If the pregnant woman seeking an abortion
is unable to read the materials, the materials shall be read to her. If the
pregnant woman seeking an abortion asks questions concerning any of the
information or materials, answers shall be provided to her in her own language.
NOTE: The provisions of this Section requiring a physician or qualified person to provide required printed materials to a woman considering an abortion shall become effective 30 days after the department publishes a notice of the availability of such materials.
5. Certification and Reporting
a. Prior to the abortion, the outpatient
abortion facility shall ensure the pregnant woman seeking an abortion has
certified, in writing on a form provided by the department that the information
and materials required were provided at least 72 hours prior to the abortion,
or at least 24 hours prior to the abortion in the case of a woman who has given
prior certification in writing that she currently lives 150 miles or more from
the nearest licensed outpatient abortion facility that is willing and able to
perform the abortion at the particular woman's stage of pregnancy. This form
shall be maintained in the woman's medical record.
b. Prior to performing the abortion, the
physician who is to perform the abortion or his agent receives a copy of the
written certification.
c. The
pregnant woman seeking an abortion is not required to pay any amount for the
abortion procedures until the 72-hour period has expired, or until expiration
of the 24-hour period applicable in the case of a woman who has given prior
certification in writing that she currently lives 150 miles or more from the
nearest licensed outpatient abortion facility that is willing and able to
perform the abortion at the particular woman's stage of pregnancy.
6. Reporting Requirements. Any
physician who has provided the information and materials to any woman in
accordance with the requirements of this Section shall provide to the
department:
a. with respect to a woman upon
whom an abortion is performed, all information as required by applicable state
laws, rules, and regulations as well as the date upon which the information and
materials required to be provided under this Section were provided, as well as
an executed copy of the certification form. This form shall be maintained in
the woman's medical record;
b. with
respect to any woman to whom the printed and oral information and materials
have been provided pursuant to applicable state laws, rules, and regulations,
but upon whom the physician has not performed an abortion, the name and address
of the facility where the required information was provided and if executed by
the woman, a copy of the certification form required. This form shall be
maintained in the woman's medical record.
7. Information Provided by the Physician
Performing or Inducing an Abortion. On the date the abortion is performed or
induced, a physician performing or inducing the abortion shall provide the
pregnant woman with all of the following before the abortion is performed or
induced:
a. a telephone number by which the
pregnant woman may reach the physician, or other health care personnel employed
by the physician or facility at which the abortion was performed or induced,
who has 24 hours per day access to the woman's relevant medical records so that
the woman may request assistance related to any complication that arises from
the performance or induction of the abortion, or to ask health-related
questions regarding the abortion; and
b. the name and telephone number of the
hospital nearest to the home of the pregnant woman at which an emergency
arising from the abortion would be treated.
8. Disposition of Fetal Remains
a. Each physician who performs or induces an
abortion which does not result in a live birth shall ensure that the remains of
the fetus are disposed of by interment or cremation, in accordance with the
provisions of
R.S.
8:651 et seq. and the provisions of LAC
51:XXVI.
b. Prior to an abortion,
the physician shall orally and in writing inform the pregnant woman seeking an
abortion in the licensed abortion facility that the pregnant woman has the
following options:
i. the option to make
arrangements for the disposition and/or disposal of fetal remains by interment
or cremation, in accordance with the provisions of
R.S.
8:651 et seq.; or
ii. the option to have the outpatient
abortion facility/physician make the arrangements for the disposition and/or
disposal of fetal remains by interment or cremation, in accordance with the
provisions of
R.S.
8:651 et seq.
c. The pregnant woman shall sign a consent
form attesting that she has been informed of these options; if the pregnant
woman wants to make arrangements for the disposition of fetal remains, she will
indicate so on the form; if no such indication is made on the form by the
pregnant woman, the outpatient abortion facility/physician shall make the
arrangements for the disposition and/or disposal of fetal remains by interment
or cremation, in accordance with the provisions of
R.S.
8:651 et seq.
d. the requirements of
§4431.G.8 regarding
dispositions of fetal remains, shall not apply to abortions induced by the
administration of medications when the evacuation of any human remains occurs
at a later time and not in the presence of the inducing physician or at the
facility in which the physician administered the inducing medications.
AUTHORITY NOTE: Promulgated in accordance with R.S. 40:2175.1 et seq.
Disclaimer: These regulations may not be the most recent version. Louisiana may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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