II 

118TH CONGRESS 

1ST SESSION S. 635 

To protect children from medical malpractice in the form of gender transition 

procedures. 

IN THE SENATE OF THE UNITED STATES 

MARCH 2, 2023 

Mr. COTTON (for himself, Mr. BRAUN, Mr. CRUZ, Mr. DAINES, Mr. 

LANKFORD, Mr. MULLIN, Mr. RUBIO, and Mr. VANCE) introduced the 

following bill; which was read twice and referred to the Committee on the 

Judiciary 

A BILL 

To protect children from medical malpractice in the form 

of gender transition procedures. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Protecting Minors 

5 from Medical Malpractice Act of 2023’’. 

6 SEC. 2. PRIVATE RIGHT OF ACTION FOR A GENDER-TRANSI7 TION PROCEDURE PERFORMED ON A MINOR. 

8 (a) IN GENERAL.—A medical practitioner, in any cir9 cumstance described in subsection (c), who performs a 


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1 gender-transition procedure on an individual who is less 

2 than 18 years of age shall, as described in subsection (b), 

3 be liable to the individual if injured (including any phys4 ical, psychological, emotional, or physiological harms) by 

5 such procedure, related treatment, or the aftereffects of 

6 the procedure or treatment. 

7 (b) PRIVATE RIGHT OF ACTION.—An individual cov8 ered by subsection (a) who receives a gender-transition 

9 procedure from a medical practitioner (or a representative, 

10 including a legal guardian, on behalf of such individual) 

11 may, not later than the day that is 30 years after the date 

12 on which the individual turns 18 years of age, bring a civil 

13 action against such medical practitioner in a court of com14 petent jurisdiction for— 

15 (1) declaratory or injunctive relief; 

16 (2) compensatory damages; 

17 (3) punitive damages; and 

18 (4) attorney’s fees and costs. 

19 (c) CIRCUMSTANCES.—For the purposes of sub20 section (a), the circumstances described in this subsection 

21 are that— 

22 (1) the medical practitioner or the individual re23 ceiving the gender-transition procedure traveled in 

24 interstate or foreign commerce, or traveled using a 

25 means, channel, facility, or instrumentality of interVerDate Sep 11 2014 04:11 Mar 15, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S635.IS S635

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1 state or foreign commerce, in furtherance of or in 

2 connection with the conduct described in subsection 

3 (a); 

4 (2) the medical practitioner used a means, 

5 channel, facility, or instrumentality of interstate or 

6 foreign commerce in furtherance of or in connection 

7 with the conduct described in subsection (a); 

8 (3) any payment of any kind was made, directly 

9 or indirectly, in furtherance of or in connection with 

10 the conduct described in subsection (a) using any 

11 means, channel, facility, or instrumentality of inter12 state or foreign commerce or in or affecting inter13 state or foreign commerce; 

14 (4) the medical practitioner transmitted in 

15 interstate or foreign commerce any communication 

16 relating to or in furtherance of the conduct de17 scribed in subsection (a) using any means, channel, 

18 facility, or instrumentality of interstate or foreign 

19 commerce or in or affecting interstate or foreign 

20 commerce by any means or in any manner, including 

21 by computer, mail, wire, or electromagnetic trans22 mission; 

23 (5) any instrument, item, substance, or other 

24 object that has traveled in interstate or foreign comVerDate Sep 11 2014 04:11 Mar 15, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S635.IS S635

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1 merce was used to perform the conduct described in 

2 subsection (a); 

3 (6) the conduct described in subsection (a) oc4 curred within the special maritime and territorial ju5 risdiction of the United States, or any territory or 

6 possession of the United States; or 

7 (7) the conduct described in subsection (a) oth8 erwise occurred in or affected interstate or foreign 

9 commerce. 

10 SEC. 3. PRESERVING FREEDOM OF CONSCIENCE AND MED11 ICAL JUDGEMENT FOR MEDICAL PROVIDERS. 

12 Notwithstanding any other provision of law, no provi13 sion of Federal law shall require, or be construed to re14 quire, a medical practitioner to perform a gender-transi15 tion procedure. 

16 SEC. 4. PROHIBITION ON FUNDING FOR CERTAIN STATES. 

17 Notwithstanding any other provision of law, any 

18 State that requires medical practitioners to perform any 

19 gender-transition procedure on an individual in the State 

20 shall be ineligible to receive any Federal funding from the 

21 Department of Health and Human Services. 

22 SEC. 5. DEFINITIONS. 

23 In this Act: 

24 (1) BIOLOGICAL SEX.—The term ‘‘biological 

25 sex’’ means the genetic classification of an individual 


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1 as male or female, as reflected in the organization 

2 of the body of such individual for a reproductive role 

3 or capacity, such as through sex chromosomes, natu4 rally occurring sex hormones, and internal and ex5 ternal genitalia present at birth, without regard to 

6 the subjective sense of identity of the individual. 

7 (2) GENDER-TRANSITION PROCEDURE.— 

8 (A) IN GENERAL.—Except as provided in 

9 subparagraph (B), the term ‘‘gender-transition 

10 procedure’’ means— 

11 (i) the prescription or administration 

12 of puberty-blocking drugs for the purpose 

13 of changing the body of an individual so 

14 that it conforms to the subjective sense of 

15 identity of the individual, in the case such 

16 identity is at odds with the individual’s bi17 ological sex; 

18 (ii) the prescription or administration 

19 of cross-sex hormones for the purpose of 

20 changing the body of an individual so that 

21 it conforms to the subjective sense of iden22 tity of the individual, in the case such 

23 identity is at odds with the individual’s bi24 ological sex; or 


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1 (iii) a surgery to change the body of 

2 an individual so that it conforms to the 

3 subjective sense of identity of the indi4 vidual, in the case such identity is at odds 

5 with the individual’s biological sex. 

6 (B) EXCEPTION.—The term ‘‘gender-tran7 sition procedure’’ does not include— 

8 (i) an intervention described in sub9 paragraph (A) that is performed on— 

10 (I) an individual with biological 

11 sex characteristics that are inherently 

12 ambiguous, such as those born with 

13 46 XX chromosomes with virilization, 

14 46 XY chromosomes with 

15 undervirilization, or having both ovar16 ian and testicular tissue; or 

17 (II) an individual with respect to 

18 whom a physician has determined 

19 through genetic or biochemical testing 

20 that the individual does not have nor21 mal sex chromosome structure, sex 

22 steroid hormone production, or sex 

23 steroid hormone action, for a biologi24 cal male or biological female; 


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1 (ii) the treatment of any infection, in2 jury, disease, or disorder that has been 

3 caused or exacerbated by the performance 

4 of an intervention described in subpara5 graph (A) without regard to whether the 

6 intervention was performed in accordance 

7 with State or Federal law or whether the 

8 intervention is covered by the private right 

9 of action under section 2; or 

10 (iii) any procedure undertaken be11 cause the individual suffers from a physical 

12 disorder, physical injury, or physical illness 

13 that would, as certified by a physician, 

14 place the individual in imminent danger of 

15 death or impairment of major bodily func16 tion unless the procedure is performed. 

17 (3) MEDICAL PRACTITIONER.—The term ‘‘med18 ical practitioner’’ means a person who is licensed, 

19 certified, or otherwise authorized by the laws of a 

20 State to administer health care in the ordinary 

21 course of the practice of the person’s profession. 

22 SEC. 6. EFFECTIVE DATE. 

23 This Act shall take effect on the date of enactment 

24 of this Act. 

Æ 


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