II 

109TH CONGRESS 

1ST SESSION S. 1264 

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. 

IN THE SENATE OF THE UNITED STATES 

JUNE 16, 2005 

Mr. CORZINE (for himself, Mrs. CLINTON, Mrs. MURRAY, Mr. LAUTENBERG, 

Mrs. BOXER, Ms. CANTWELL, Mr. KENNEDY, Mr. INOUYE, and Mr. 

KERRY) introduced the following bill; which was read twice and referred 

to the Committee on Health, Education, Labor, and Pensions 

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. 

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 ‘‘Compassionate Assist5 ance for Rape Emergencies Act’’. 

6 SEC. 2. FINDINGS. 

7 The Congress finds as follows: 
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1 (1) It is estimated that 25,000 to 32,000 

2 women become pregnant each year as a result of 

3 rape or incest. An estimated 22,000 of these preg4 nancies could be prevented if rape survivors had 

5 timely access to emergency contraception. 

6 (2) A 1996 study of rape-related pregnancies 

7 (published in the American Journal of Obstetrics 

8 and Gynecology) found that 50 percent of the preg9 nancies described in paragraph (1) ended in abor10 tion. 

11 (3) Surveys have shown that many hospitals do 

12 not routinely provide emergency contraception to 

13 women seeking treatment after being sexually as14 saulted. 

15 (4) The risk of pregnancy after sexual assault 

16 has been estimated to be 4.7 percent in survivors 

17 who were not protected by some form of contracep18 tion at the time of the attack. 

19 (5) The Food and Drug Administration has de20 clared emergency contraception to be safe and effec21 tive in preventing unintended pregnancy, reducing 

22 the risk by as much as 89 percent if taken within 

23 days of unprotected intercourse and up to 95 per24 cent if taken in the first 24 hours. 
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1 (6) Medical research strongly indicates that the 

2 sooner emergency contraception is administered, the 

3 greater the likelihood of preventing unintended preg4 nancy. 

5 (7) In light of the safety and effectiveness of 

6 emergency contraceptive pills, both the American 

7 Medical Association and the American College of 

8 Obstetricians and Gynecologists have endorsed more 

9 widespread availability of such pills. 

10 (8) The American College of Emergency Physi11 cians and the American College of Obstetricians and 

12 Gynecologists agree that offering emergency contra13 ception to female patients after a sexual assault 

14 should be considered the standard of care. 

15 (9) Approximately 30 percent of American 

16 women of reproductive age are unaware of the avail17 ability of emergency contraception. 

18 (10) New data from a survey of women having 

19 abortions estimates that 51,000 abortions were pre20 vented by use of emergency contraception in 2000 

21 and that increased use of emergency contraception 

22 accounted for 43 percent of the decrease in total 

23 abortions between 1994 and 2000. 

24 (11) It is essential that all hospitals that pro25 vide emergency medical treatment provide emergency 
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1 contraception as a treatment option to any woman 

2 who has been sexually assaulted, so that she may 

3 prevent an unintended pregnancy. 

4 (12) Victims of sexual assault are at increased 

5 risk of contracting sexually transmitted diseases. 

6 (13) Some sexually-transmitted infections can7 not be reliably cured if treatment is delayed, and 

8 may result in high morbidity and mortality. HIV has 

9 killed over 520,000 Americans, and the Centers for 

10 Disease Control and Prevention currently estimates 

11 that over 1,000,000 Americans are infected with the 

12 virus. Even modern drug treatment has failed to 

13 cure infected individuals. Nearly 80,000 Americans 

14 are infected with hepatitis B each year, with some 

15 individuals unable to fully recover. An estimated 

16 1,250,000 Americans remain chronically infected 

17 with the hepatitis B virus and at present, one in five 

18 of these may expect to die of liver failure. 

19 (14) It is possible to prevent some sexually 

20 transmitted diseases by treating an exposed indi21 vidual promptly. The use of post-exposure prophy22 laxis using antiretroviral drugs has been dem23 onstrated to effectively prevent the establishment of 

24 HIV infection. Hepatitis B infection may also be 
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1 eliminated if an exposed individual receives prompt 

2 treatment. 

3 (15) The Centers for Disease Control and Pre4 vention has recommended risk evaluation and appro5 priate application of post-exposure treatment for vic6 tims of sexual assault. For such individuals, imme7 diate treatment is the only means to prevent a life 

8 threatening infection. 

9 (16) It is essential that all hospitals that pro10 vide emergency medical treatment provide assess11 ment and treatment of sexually-transmitted infec12 tions to minimize the harm to victims of sexual as13 sault. 

14 SEC. 3. SURVIVORS OF SEXUAL ASSAULT; PROVISION BY 

15 HOSPITALS OF EMERGENCY CONTRACEP16 TIVES WITHOUT CHARGE. 

17 (a) IN GENERAL.—Federal funds may not be pro18 vided to a hospital under any health-related program, un19 less the hospital meets the conditions specified in sub20 section (b) in the case of— 

21 (1) any woman who presents at the hospital 

22 and states that she is a victim of sexual assault, or 

23 is accompanied by someone who states she is a vic24 tim of sexual assault; and 
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1 (2) any woman who presents at the hospital 

2 whom hospital personnel have reason to believe is a 

3 victim of sexual assault. 

4 (b) ASSISTANCE FOR VICTIMS.—The conditions spec5 ified in this subsection regarding a hospital and a woman 

6 described in subsection (a) are as follows: 

7 (1) The hospital promptly provides the woman 

8 with medically and factually accurate and unbiased 

9 written and oral information about emergency con10 traception, including information explaining that— 

11 (A) emergency contraception has been ap12 proved by the Food and Drug Administration 

13 as a safe and effective way to prevent preg14 nancy after unprotected intercourse or contra15 ceptive failure if taken in a timely manner, and 

16 is more effective the sooner it is taken; and 

17 (B) emergency contraception does not 

18 cause an abortion and cannot interrupt an es19 tablished pregnancy. 

20 (2) The hospital promptly offers emergency 

21 contraception to the woman, and promptly provides 

22 such contraception to her at the hospital on her re23 quest. 

24 (3) The information provided pursuant to para25 graph (1) is in clear and concise language, is readily 
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1 comprehensible, and meets such conditions regarding 

2 the provision of the information in languages other 

3 than English as the Secretary may establish. 

4 (4) The services described in paragraphs (1) 

5 through (3) are not denied because of the inability 

6 of the woman to pay for the services. 

7 SEC. 4. PREVENTION OF TRANSMISSIBLE DISEASE. 

8 (a) IN GENERAL.—No hospital shall receive Federal 

9 funds unless such hospital provides risk assessment, coun10 seling, and treatment as required under this section to a 

11 survivor of sexual assault described in subsection (b). 

12 (b) SURVIVORS OF SEXUAL ASSAULT.—An individual 

13 is a survivor of a sexual assault as described in this sub14 section if the individual— 

15 (1) presents at the hospital and declares that 

16 the individual is a victim of sexual assault, or the in17 dividual is accompanied to the hospital by another 

18 individual who declares that the first individual is a 

19 victim of a sexual assault; or 

20 (2) presents at the hospital and hospital per21 sonnel have reason to believe the individual is a vic22 tim of sexual assault. 

23 (c) REQUIREMENT FOR RISK ASSESSMENT, COUN24 SELING, AND TREATMENT.—The following shall apply 

25 with respect to a hospital described in subsection (a): 
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1 (1) RISK ASSESSMENT.—A hospital shall 

2 promptly provide a survivor of a sexual assault with 

3 an assessment of the individual’s risk for contracting 

4 sexually transmitted infections as described in para5 graph (2)(A), which shall be conducted by a licensed 

6 medical professional and be based upon— 

7 (A) available information regarding the as8 sault as well as the subsequent findings from 

9 medical examination and any tests that may be 

10 conducted; and 

11 (B) established standards of risk assess12 ment which shall include consideration of any 

13 recommendations established by the Centers for 

14 Disease Control and Prevention, and may also 

15 incorporate findings of peer-reviewed clinical 

16 studies and appropriate research utilizing in 

17 vitro and non-human primate models of infec18 tion. 

19 (2) COUNSELING.—A hospital shall provide a 

20 survivor of a sexual assault with advice, provided by 

21 a licensed medical professional, concerning— 

22 (A) significantly prevalent sexually trans23 missible infections for which effective post-expo24 sure prophylaxis exists, and for which the defer25 ral of treatment would either significantly re-
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1 duce treatment efficacy or would pose substan2 tial risk to the individual’s health; and 

3 (B) the requirement that prophylactic 

4 treatment for infections as described in sub5 paragraph (A) shall be provided to the indi6 vidual upon request, regardless of the ability of 

7 the individual to pay for such treatment. 

8 (3) TREATMENT.—A hospital shall provide a 

9 survivor of a sexual assault, upon request, with pro10 phylactic treatment for infections described in para11 graph (2)(A). 

12 (4) ABILITY TO PAY.—The services described in 

13 paragraphs (1) through (3) shall not be denied be14 cause of the inability of the individual involved to 

15 pay for the services. 

16 (5) LANGUAGE.—Any information provided 

17 pursuant to this subsection shall be clear and con18 cise, readily comprehensible, and meet such condi19 tions regarding the provision of the information in 

20 languages other than English as the Secretary may 

21 establish. 

22 (d) RULE OF CONSTRUCTION.—Nothing in this sec23 tion shall be construed to— 

24 (1) require that a hospital provide prophylactic 

25 treatment for a victim of sexual assault when risk 
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1 evaluation according to criteria adopted by the Cen2 ters for Disease Control and Prevention clearly rec3 ommend against the application of post-exposure 

4 prophylaxis; 

5 (2) prohibit a hospital from seeking reimburse6 ment for the cost of services provided under this sec7 tion to the extent that health insurance may reim8 burse for such services; and 

9 (3) establish a requirement that any victim of 

10 sexual assault submit to diagnostic testing for the 

11 presence of any infectious disease. 

12 (e) LIMITATION.—Federal funds may not be provided 

13 to a hospital under any health-related program unless the 

14 hospital complies with the requirements of this section. 

15 SEC. 5. DEFINITIONS. 

16 In this Act: 

17 (1) EMERGENCY CONTRACEPTION.—The term 

18 ‘‘emergency contraception’’ means a drug, drug regi19 men, or device that is— 

20 (A) approved by the Food and Drug Ad21 ministration to prevent pregnancy; and 

22 (B) is used postcoitally. 

23 (2) HOSPITAL.—The term ‘‘hospital’’ has the 

24 meaning given such term in title XVIII of the Social 

25 Security Act, including the meaning applicable in 
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1 such title for purposes of making payments for 

2 emergency services to hospitals that do not have 

3 agreements in effect under such title. Such term in4 cludes a health care facility that is located within, or 

5 contracted to, a correctional institution or a post6 secondary educational institution. 

7 (3) LICENSED MEDICAL PROFESSIONAL.—The 

8 term ‘‘licensed medical professional’’ means a doctor 

9 of medicine, doctor of osteopathy, registered nurse, 

10 physician assistant, or any other healthcare profes11 sional determined appropriate by the Secretary. 

12 (4) SECRETARY.—The term ‘‘Secretary’’ means 

13 the Secretary of Health and Human Services. 

14 (5) SEXUAL ASSAULT.— 

15 (A) IN GENERAL.—The term ‘‘sexual as16 sault’’ means a sexual act (as defined in sub17 paragraphs (A) through (C) of section 2246(2) 

18 of title 18, United States Code) where the vic19 tim involved does not consent or lacks the ca20 pacity to consent. 

21 (B) APPLICATION OF PROVISIONS.—The 

22 definition under subparagraph (A) shall— 

23 (i) in the case of section 2, apply to 

24 males and females, as appropriate; 
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1 (ii) in the case of section 3, apply only 

2 to females; and 

3 (iii) in the case of section 4, apply to 

4 all individuals. 

5 SEC. 6. EFFECTIVE DATE; AGENCY CRITERIA. 

6 This Act shall take effect upon the expiration of the 

7 180-day period beginning on the date of the enactment 

8 of this Act. Not later than 30 days prior to the expiration 

9 of such period, the Secretary of Health and Human Serv10 ices shall publish in the Federal Register criteria for car11 rying out this Act. 

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