[Congressional Record Volume 151, Number 80 (Thursday, June 16, 2005)]
[Senate]
[Pages S6759-S6761]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CORZINE (for himself, Mrs. Clinton, Mrs. Murray, Mr. 
        Lautenberg, Mrs. Boxer, Ms. Cantwell, Mr. Kennedy, Mr. Inouye, 
        and Mr. Kerry):
  S. 1264. 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; to the Committee on Health, Education, Labor, and 
Pensions.
  Mr. CORZINE. Mr. President, I rise today to introduce the 
Compassionate Assistance for Rape Emergencies Act. In the United 
States, more than 300,000 women are raped each year and an estimated 
25,000 to 32,000 become pregnant as a result. That is why I am 
reintroducing the Compassionate Assistance

[[Page S6760]]

in Rape Emergencies Act, or CARE Act.
  This bill will ensure that women who are survivors of sexual assault 
have access to the medical care they need, including emergency 
contraception. Emergency contraception reduces a woman's risk of 
becoming pregnant by up to 89 percent when taken within 72 hours of the 
assault. I want to be clear: emergency contraception does not end a 
pregnancy. Instead, emergency contraception works before a pregnancy 
can occur.
  There is widespread consensus in the medical community that emergency 
contraception is safe and effective. Yet, New Jersey is one of only six 
States that legally require all medical providers to offer this care to 
rape survivors. Before this law, one-third of New Jersey's hospitals 
did not provide this vital medication. New Jersey's law should be the 
national standard. The bill would require that all hospitals that 
receive Federal funding offer information and access to emergency 
contraception for victims of rape.
  In January of this year I, along with 21 Senators, wrote a letter to 
the Department of Justice asking that they include information about 
emergency contraception in their national protocol for sexual assault 
hospital examinations. But they did not. In all 141 pages, the protocol 
fails to provide sexual assault victims with access to this needed 
information and treatment. The protocol instead leaves the door open 
for health care professionals to decide whether or not to discuss 
certain treatment options. Today, I want to close that door.
  In order to provide comprehensive medical care, hospitals must also 
provide quick access to preventive medication that helps protect 
victims of sexual assault from potentially fatal sexually transmitted 
diseases, such as HIV and hepatitis B. We have an obligation to protect 
sexual assault victims from these life threatening infections.
  We must not sit idly by while so many sexual assault survivors are 
deprived the medical care they need and deserve. Once these survivors 
seek treatment we ought to make sure that they get the treatment they 
need. Ideology should never stand between patients and the care they 
deserve.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1264

       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.

       The Congress finds as follows:
       (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 survivors had timely access to emergency contraception.
       (2) A 1996 study of rape-related pregnancies (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.
       (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 the standard of 
     care.
       (9) Approximately 30 percent of American 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 
     Americans, and the Centers for Disease Control and Prevention 
     currently estimates that over 1,000,000 Americans are 
     infected with the virus. Even modern drug treatment has 
     failed to cure infected individuals. Nearly 80,000 Americans 
     are infected with hepatitis B each year, with some 
     individuals unable to fully recover. An estimated 1,250,000 
     Americans remain chronically infected with the hepatitis B 
     virus and at present, one in five of these 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. 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 presents 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 presents 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) 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) The hospital promptly offers emergency contraception to 
     the woman, and promptly provides such contraception to her at 
     the hospital on her request.
       (3) 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) The services described in paragraphs (1) through (3) 
     are not denied because of the inability of the woman to pay 
     for the services.

     SEC. 4. PREVENTION OF TRANSMISSIBLE DISEASE.

       (a) In General.--No hospital shall receive Federal funds 
     unless such 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 as described in this subsection 
     if the individual--
       (1) presents at the hospital and declares that the 
     individual is a victim of sexual assault, or the individual 
     is accompanied to the hospital by another individual who 
     declares that the first individual is a victim of a sexual 
     assault; or
       (2) presents 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 for contracting sexually transmitted 
     infections as described in paragraph (2)(A), which 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

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     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 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 transmissible 
     infections for which effective post-exposure prophylaxis 
     exists, and for which the deferral of treatment would either 
     significantly reduce treatment efficacy or would pose 
     substantial risk to the individual's health; and
       (B) the requirement that prophylactic treatment for 
     infections as 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 evaluation according 
     to criteria adopted by the Centers for Disease Control and 
     Prevention clearly recommend 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 reimburse 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.
       (e) Limitation.--Federal funds may not be provided to a 
     hospital under any health-related program unless the hospital 
     complies with the requirements of this section.

     SEC. 5. DEFINITIONS.

       In this Act:
       (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, 
     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 
     contracted to, 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 healthcare professional determined appropriate by the 
     Secretary.
       (4) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (5) Sexual assault.--
       (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 under 
     subparagraph (A) shall--
       (i) in the case of section 2, apply to males and females, 
     as appropriate;
       (ii) in the case of section 3, apply only to females; and
       (iii) in the case of section 4, apply to all individuals.

     SEC. 6. EFFECTIVE DATE; AGENCY CRITERIA.

       This Act shall take effect upon the expiration of the 180-
     day period beginning on the date of the enactment of this 
     Act. Not later than 30 days prior to the expiration of such 
     period, the Secretary of Health and Human Services shall 
     publish in the Federal Register criteria for carrying out 
     this Act.
                                 ______