PIERRE, S.D. (KELO) — As of Jan. 20, 2023, and with a little under two weeks left to submit legislation, South Dakota legislators have introduced three bills that would impact the abilities of medical providers in the state.

These are House Bills 1053, 1080 and 1102.

HB 1053 was introduced by Republican Rep. Fred Deutsch for the purpose of prohibiting medical personnel from providing certification for medical marijuana to people who are pregnant or breastfeeding.

The bill would amend existing law to exclude a person who is pregnant or breastfeeding from the definition of a “qualifying patient,” and also add a line excluding “nausea associated with pregnancy” from the list of qualifying medical conditions.

SB 1, a bill dealing with an expansion of conditions was heard in committee Wednesday, where some committee members voiced feelings that decisions on which conditions should be treated with which drugs should be left up to the patient and physician, with the physician having the final say.

I think the physicians who will be looking at recommending medical cannabis are going to understand the science that they research related to the conditions they specialize in, and they’re going to know their patient better than anyone. I think that’s really where the decision should be made.

Republican Senator Michael Diedrich in a committee hearing on SB 1

Similar arguments may be expected in consideration of this bill.

HB 1080 was introduced by Republican Rep. Bethany Soye and would “prohibit certain medical and surgical interventions on minor patients.”

This bill would ban medical practitioners from providing gender-affirming care to transgender youths by measures such as prescribing or administering puberty blockers or certain hormones, and performing certain surgeries.

While the Sioux Falls lawmaker’s bill would ban surgery on trans youths, it does specifically allow for surgery to be carried out in children born intersex, or as the bill puts it “born with a medically verifiable disorder of sex development, including external biological sex characteristics that are irresolvably ambiguous.”

Ambiguous genitalia, now an outdated term, refers to atypical genitalia, which is also known as intersex. Atypical genitalia is a rare condition where an infants external genitals do not appear typically male or female.

In such a case, the genitalia may be incompletely developed, the infant may have characteristics of both sexes, or the external sex organs may not match the internal sex organs.

Many researchers argue that surgeries on intersex infants, aside from emergency procedures such as in the case that the infant is unable to urinate properly, are unethical.

Rather, groups such as Human Rights Watch advocate delaying procedures until the individual is able to participate in a discussion of what surgery, if any, should be done. The Mayo Clinic also warns that gender assignment can be complex and the long-term impact can be difficult to predict.

Parents should be aware that as the child grows up, he or she may make a different decision about gender identification.

Mayo Clinic warning on parents selecting a gender for an intersex child

The bill also includes provisions to penalize practitioners who violate the statute.

In the event that the bill were to pass, it includes a provision relating to any treatment of transgender youths that may be in-process at the time the bill takes effect.

Under this provision, if the practitioner determines that the immediate termination of treatment would cause harm, they would be given a five-month window to reduce dosages.

HB 1102, also introduced by Deutsch, seeks to add requirements related to the process through which practitioners certify the presence of a condition suitable for treatment of medical marijuana.

Under current law, a practitioner must have a bona fide practitioner-patient relationship with a practitioner licensed in South Dakota, who must conduct an in-person consultation with the patient and be available for follow-up care.

Deutsch’s bill would add requirements that the practitioner conduct not just an in-person examination, but also a follow up interaction before recommending them for the use of marijuana.

The bill also requires that the practitioner carry out extensive certifications to be provided to the DOH, including:

  1. A certification that the patient is under the practitioner’s care for a debilitating medical condition;
  2. A certification that the patient has been diagnosed with a qualifying debilitating medical condition or symptom associated with the debilitating medical condition;
  3. A certification that the diagnosis has been made in the course of a bona fide practitioner-patient relationship;
  4. A certification that the practitioner has assessed the patient’s medical history and current medical condition, including an in-person physical examination;
  5. A certification that the practitioner has developed a treatment plan for the patient’s medical use of cannabis;
  6. A certification that the practitioner has evaluated any medical cannabis contraindications with any other drug the patient is taking, assessed other medical conditions the patient has, and discussed with the patient any associated risks of taking medical cannabis considering the patient’s medical condition;
  7. A certification that the practitioner has considered the clinical status of the patient and has offered or recommended follow-up care with the patient or the patient’s parents or legal guardian to monitor the patient’s medical use of cannabis;
  8. A certification that the practitioner-patient relationship is not for the sole purpose of providing a written certification to the patient, unless the patient has been referred by a practitioner providing the patient continuing care;
  9. The practitioner’s name, address, and phone number;
  10. The practitioner’s South Dakota license and National Practitioner Identification numbers, if applicable;
  11. The dates of each interaction, whether by phone, virtually, or in-person, with the patient in the twelve months immediately preceding the date of the written certification;
  12. The date on which the last in-person physical examination was conducted;
  13. If the patient was referred by a practitioner providing the patient continuing care, the name and address of the referring practitioner;
  14. If the patient was referred by a practitioner providing the patient continuing care, a certification that medical records or a visit summary including the treatment plan will be sent to the referring practitioner following the office visit related to the use of medical cannabis;
  15. The date of expiration of the written certification, not to exceed one year from the date of issuance; and
  16. The number of designated caregivers, if more than one, that the patient’s age or medical condition necessitates.

Each of these must be submitted in writing to the DOH.

The bill also includes rules regarding how practitioners or their employers may advertise, as well as penalties for violating them.