II 

109TH CONGRESS 

2D SESSION S. 3945 

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 

SEPTEMBER 26, 2006 

Mrs. CLINTON (for herself, Mrs. MURRAY, Mr. LAUTENBERG, Mrs. BOXER, 

Mr. MENENDEZ, Ms. CANTWELL, Mr. KENNEDY, Mr. INOUYE, Mr. 

KERRY, Mr. JEFFORDS, and Mr. CHAFEE) 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 Congress finds the following: 


jcorcoran on PRODPC62 with BILLS
2 

•S 3945 IS

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 or incest survivors 

5 had timely access to emergency contraception. 

6 (2) A 1996 study of pregnancies resulting from 

7 rape or incest (published in the American Journal of 

8 Obstetrics and Gynecology) found that 50 percent of 

9 the pregnancies described in paragraph (1) ended in 

10 abortion. 

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 after unprotected 

25 intercourse. 


jcorcoran on PRODPC62 with BILLS
3 

•S 3945 IS

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 part of the standard of care. 

15 (9) Approximately 30 percent of United States 

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 


jcorcoran on PRODPC62 with BILLS
4 

•S 3945 IS

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 individuals in the United States, 

10 and the Centers for Disease Control and Prevention 

11 currently estimates that over 1,000,000 individuals 

12 in the United States are infected with the virus. 

13 Even modern drug treatment has failed to cure in14 fected individuals. Nearly 80,000 individuals in the 

15 United States are infected with hepatitis B each 

16 year, with some individuals unable to fully recover. 

17 An estimated 1,250,000 individuals in the United 

18 States remain chronically infected with the hepatitis 

19 B virus and at present, 1 in 5 of those infected indi20 viduals may expect to die of liver failure. 

21 (14) It is possible to prevent some sexually 

22 transmitted diseases by treating an exposed indi23 vidual promptly. The use of post-exposure prophy24 laxis using antiretroviral drugs has been dem25 onstrated to effectively prevent the establishment of 


jcorcoran on PRODPC62 with BILLS
5 

•S 3945 IS

1 HIV infection. Hepatitis B infection may also be 

2 eliminated if an exposed individual receives prompt 

3 treatment. 

4 (15) The Centers for Disease Control and Pre5 vention has recommended risk evaluation and appro6 priate application of post-exposure treatment for vic7 tims of sexual assault. For such individuals, imme8 diate treatment is the only means to prevent a life9 threatening infection. 

10 (16) It is essential that all hospitals that pro11 vide emergency medical treatment provide assess12 ment and treatment of sexually transmitted infec13 tions to minimize the harm to victims of sexual as14 sault. 

15 SEC. 3. 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 (42 U.S.C. 1395 et seq.), including the 


jcorcoran on PRODPC62 with BILLS
6 

•S 3945 IS

1 meaning applicable in such title for purposes of 

2 making payments for emergency services to hospitals 

3 that do not have agreements in effect under such 

4 title. Such term includes a health care facility that 

5 is located within, or that enters into a contract with, 

6 a correctional institution or a post-secondary edu7 cational institution. 

8 (3) LICENSED MEDICAL PROFESSIONAL.—The 

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

10 of medicine, doctor of osteopathy, registered nurse, 

11 physician assistant, or any other health care profes12 sional determined to be appropriate by the Sec13 retary. 

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

15 the Secretary of Health and Human Services. 

16 (5) SEXUAL ASSAULT.— 

17 (A) IN GENERAL.—The term ‘‘sexual as18 sault’’ means a sexual act (as defined in sub19 paragraphs (A) through (C) of section 2246(2) 

20 of title 18, United States Code) where the vic21 tim involved does not consent or lacks the ca22 pacity to consent. 

23 (B) APPLICATION OF PROVISIONS.—The 

24 definition in subparagraph (A) shall— 


jcorcoran on PRODPC62 with BILLS
7 

•S 3945 IS

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

2 males and females, as appropriate; 

3 (ii) in the case of section 4, apply only 

4 to females; and 

5 (iii) in the case of section 5, apply to 

6 all individuals. 

7 SEC. 4. SURVIVORS OF SEXUAL ASSAULT; PROVISION BY 

8 HOSPITALS OF EMERGENCY CONTRACEP9 TIVES WITHOUT CHARGE. 

10 (a) IN GENERAL.—Federal funds may not be pro11 vided to a hospital under any health-related program, un12 less the hospital meets the conditions specified in sub13 section (b) in the case of— 

14 (1) any woman who arrives at the hospital and 

15 states that she is a victim of sexual assault, or is ac16 companied by someone who states she is a victim of 

17 sexual assault; and 

18 (2) any woman who arrives at the hospital 

19 whom hospital personnel have reason to believe is a 

20 victim of sexual assault. 

21 (b) ASSISTANCE FOR VICTIMS.—The conditions spec22 ified in this subsection regarding a hospital and a woman 

23 described in subsection (a) are as follows: 

24 (1) INFORMATION.—The hospital promptly pro25 vides the woman with medically and factually accuVerDate Aug 31 2005 00:45 Sep 28, 2006 Jkt 049196 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S3945.IS S3945

jcorcoran on PRODPC62 with BILLS
8 

•S 3945 IS

1 rate and unbiased written and oral information 

2 about emergency contraception, including informa3 tion explaining that— 

4 (A) emergency contraception has been ap5 proved by the Food and Drug Administration 

6 as a safe and effective way to prevent preg7 nancy after unprotected intercourse or contra8 ceptive failure if taken in a timely manner, and 

9 is more effective the sooner it is taken; and 

10 (B) emergency contraception does not 

11 cause an abortion and cannot interrupt an es12 tablished pregnancy. 

13 (2) EMERGENCY CONTRACEPTION.—The hos14 pital promptly offers emergency contraception to the 

15 woman, and promptly provides such contraception to 

16 her at the hospital on her request. 

17 (3) CONDITIONS FOR INFORMATION.—The in18 formation provided pursuant to paragraph (1) is in 

19 clear and concise language, is readily comprehen20 sible, and meets such conditions regarding the provi21 sion of the information in languages other than 

22 English as the Secretary may establish. 

23 (4) PROVISION DESPITE INABILITY TO PAY.— 

24 The services described in paragraphs (1) through (3) 


jcorcoran on PRODPC62 with BILLS
9 

•S 3945 IS

1 are not denied because of the inability of the woman 

2 to pay for the services. 

3 SEC. 5. PREVENTION OF øSEXUALLY TRANSMITTED¿ DIS4 EASE. 

5 (a) IN GENERAL.—Federal funds may not be pro6 vided to a hospital under any health-related program, un7 less the hospital provides risk assessment, counseling, and 

8 treatment as required under this section to a survivor of 

9 sexual assault described in subsection (b). 

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

11 is a survivor of a sexual assault described in this sub12 section if the individual— 

13 (1) arrives at the hospital and states that the 

14 individual is a victim of sexual assault, or is accom15 panied to the hospital by another individual who de16 clares that the first individual is a victim of sexual 

17 assault; or 

18 (2) arrives at the hospital and hospital per19 sonnel have reason to believe the individual is a vic20 tim of sexual assault. 

21 (c) REQUIREMENT FOR RISK ASSESSMENT, COUN22 SELING, AND TREATMENT.—The following shall apply 

23 with respect to a hospital described in subsection (a): 

24 (1) RISK ASSESSMENT.—A hospital shall 

25 promptly provide a survivor of a sexual assault with 


jcorcoran on PRODPC62 with BILLS
10 

•S 3945 IS

1 an assessment of the individual’s risk of contracting 

2 sexually transmitted infections described in para3 graph (2)(A), which assessment shall be conducted 

4 by a licensed medical professional and be based 

5 upon— 

6 (A) available information regarding the as7 sault as well as the subsequent findings from 

8 medical examination and any tests that may be 

9 conducted; and 

10 (B) established standards of risk assess11 ment which shall include consideration of any 

12 recommendations established by the Centers for 

13 Disease Control and Prevention, and may also 

14 incorporate consideration of findings of peer-re15 viewed clinical studies and appropriate research 

16 utilizing in vitro and non-human primate mod17 els of infection. 

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

19 survivor of a sexual assault with advice, provided by 

20 a licensed medical professional, concerning— 

21 (A) significantly prevalent sexually trans22 mitted infections for which effective post-expo23 sure prophylaxis exists, and for which the defer24 ral of treatment would either significantly reVerDate Aug 31 2005 00:45 Sep 28, 2006 Jkt 049196 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S3945.IS S3945

jcorcoran on PRODPC62 with BILLS
11 

•S 3945 IS

1 duce treatment efficacy or pose substantial risk 

2 to the individual’s health; and 

3 (B) the requirement that prophylactic 

4 treatment for infections described in subpara5 graph (A) shall be provided to the individual 

6 upon request, regardless of the ability of the in7 dividual 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 


jcorcoran on PRODPC62 with BILLS
12 

•S 3945 IS

1 assessment (according to recommendations estab2 lished by the Centers for Disease Control and Pre3 vention) clearly recommends against the application 

4 of post-exposure 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 provide 

8 reimbursement 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 SEC. 6. AGENCY CRITERIA. 

13 Not later than 30 days prior to the expiration of the 

14 period described in section 7, the Secretary shall publish 

15 in the Federal Register criteria for meeting the conditions 

16 described in sections 4 and 5. 

17 SEC. 7. EFFECTIVE DATE. 

18 This Act takes effect on the expiration of the 180- 

19 day period beginning on the date of the enactment of this 

20 Act. 

Æ 


jcorcoran on PRODPC62 with BILLS