Ron DeSantis and the ‘Let Them Die Act’

On May 15 2023, an Imgur account shared a recent tweet by Alejandra Caraballo (@Esqueer_) describing purported legislation in Florida as the “Let Them Die Act”:

In a tweet directly underneath, Caraballo explained that the “Let Them Die Act” was not the official bill name (and substantiated the first tweet’s claim about a car accident):

Caraballo shared a link to a May 2023 LGBTQNation.com article published on May 12 2023. A separate May 15 2023 post on Reddit’s r/WhitePeopleTwitter showed a different tweet with the same linked article:

The most upvoted comment answered the question posed in that post (“How would Ron DeSantis respond if one of his children ‘came out’ as gay or trans?”):

How would he respond? He’d be privately fine with it, use his resources and connections to make sure their life was not affected by his policies, and continue pushing this bullshit on everyone else until it became public knowledge, at which point he’d have a “change of heart.”

See, e.g., Cheney, Dick.

On May 12 2023, LGBTQNation.com published a story identifying the name and scope of the legislation:

Florida Gov. Ron DeSantis (R) has signed the “Protections of Medical Conscience Act,” a law that allows healthcare providers or payors to deny service on the basis of “a conscience-based objection,” including any ethical, moral, or religious beliefs. The bill provides no definition for what constitutes a “moral” or “ethical” belief.

[…]

The law allows any medical provider — including doctors, nurses, ambulance drivers, pharmacists, mental health professionals, lab technicians, nursing home workers, and hospital administrators — as well as insurance companies and payment entities, the right to deny care on the basis of any conscientious objection. This care can include refusing to conduct research and recordkeeping or denying medical tests, diagnoses, referrals, medications, and therapy, the American Civil Liberties Union (ACLU) notes.

In the excerpt above, the portion referencing the American Civil Liberties Union linked to an April 19 2023 statement from the ACLU of Florida, grimly titled “ACLU of Florida Statement on Bill That Allows Healthcare Providers and Payors to Refuse Healthcare to Floridians.”

It continued not mincing words, identifying the legislation as Senate Bill 1580 (or SB 1580):

TALLAHASSEE, Fla. – The Senate Rules Committee voted [on April 19 2023] to pass Senate Bill 1580 (SB 1580), which would allow healthcare providers and payors to refuse to provide healthcare services to Floridians based on their “moral,” “ethical,” or “religious” beliefs. Additionally, the bill would prevent employers from taking any adverse actions against any employee that refuses to provide care based on their “moral,” “ethical,” or “religious” beliefs –thus forcing employers to retain employees who refuse to do their jobs.

This bill is overly broad and includes any healthcare provider or facility licensed under a dozen different statutes, including doctors, nurses, pharmacies, hospitals, mental health providers, medical transport services, clinical lab personnel, nursing homes, and more.

Additionally, the bill allows providers to refuse to provide any type of “healthcare service,” broadly defined as including, but not limited to, medical research, medical procedures, testing, diagnosis, referral, dispensing medications, therapy, recordkeeping, and “any other care or service.”

The bill broadly defines healthcare payors to include any employer, as well as any health insurer, health plan, HMO, or “any other entity that pays for, or arranges for payment of, any health care service.”

The ACLU of Florida opposes this bill and its companion bill, House Bill 1403 (HB 1403). Both bills have passed all their assigned committees and are set to reach a full floor vote within their respective chambers [in late April 2023].

In a short few paragraphs, the ACLU of Florida outlined SB 1580 and a “companion bill,” House Bill/HB 1403. “Broad” and “overly broad” appeared repeatedly in the press release, describing a comprehensively wide scope of healthcare entities and payors (in other words, insurance companies).

Caraballo’s tweet indicated that DeSantis had “just signed” the bill in a May 13 2023 tweet. On May 11 2023, the Pensacola News Journal published “DeSantis signs controversial medical conscience bill, touts Florida as ‘Prescribe Freedom’ state,” quoting one of the bill’s sponsors:

Senate Bill 1580, “Protections of Medical Conscience,” allows Florida health care providers and payors to refuse services based on their moral, ethical or religious beliefs. The bill was one of more than a dozen bills closely watched by LGBTQ advocates who were concerned health care providers and insurers would use it to deny health care or coverage of health care to transgender people.

The legislation defined “conscience-based objection” as based on “a sincerely held religious, moral, or ethical belief.”

Rudman, however, argued that he sponsored the bill because society has gone to “Dr. Google,” … “If you ask for something you shouldn’t get done, we’re going to tell you we do not recommend that,” he said.

Asked if that wasn’t something a physician could already do, Rudman suggested a look toward California to “see where states could potentially be headed.”

“We want to establish ourselves as the anti-California,” he said.

On May 11 2023, the Florida governor’s office issued a press release titled “Governor Ron DeSantis Signs the Strongest Legislation in the Nation for Medical Freedom”:

DESTIN, Fla. — Today [on May 11 2023], Governor Ron DeSantis signed four pieces of legislation that protect Floridians from medical mandates, empower doctors, and prohibit dangerous gain of function research. Through these comprehensive pieces of legislation, Governor DeSantis codified permanent COVID-19 protections in the state and positioned Florida as the national leader for medical freedom. For more information, click here.

“Click here” opened the following PDF file:

What was described as the “Let Them Die Act” was the legislation summarized in the “Broadest Medical Conscience Protections in U.S.” section. On the flyer, DeSantis’ office described the legislation as aimed at safeguarding “the free speech of doctors,” protecting “medical professionals who choose not to use a certain treatment,” and providing a path for doctors “speaking out against the medical establishment.”

In the statement, DeSantis’ office linked to a PDF version of the bill; a version in HTML was also available. Its landing page was prefaced:

CS/SB 1580: Protections of Medical Conscience
GENERAL BILL by Rules ; Trumbull ; (CO-INTRODUCERS) Perry

Protections of Medical Conscience; Providing that health care providers and health care payors have the right to opt out of participation in or payment for certain health care services on the basis of conscience-based objections; providing requirements for a health care provider’s notice and documentation of such objection; providing whistle-blower protections for health care providers and health care payors that take certain actions or disclose certain information relating to the reporting of certain violations; prohibiting boards, or the Department of Health if there is no board, from taking disciplinary action against or denying a license to an individual based solely on specified conduct, etc.

Effective Date: 7/1/2023
Last Action: 5/12/2023 – Chapter No. 2023-57
Bill Text: Web Page | PDF

Section one of the bill defined the “overly broad” entities affected by its provisions. Section two was underlined (indicating an “addition” instead of an “omission”):

(2) RIGHT OF MEDICAL CONSCIENCE.—

(a) A health care provider or health care payor has the right to opt out of participation in or payment for any health care service on the basis of a conscience-based objection. A health care provider must, at the time of the conscience-based objection or as soon as practicable thereafter, provide written notice of his or her conscience-based objection to the health care provider’s supervisor or employer, if applicable, and document his or her conscience-based objection to a particular health care service in the patient’s medical file. Additionally, if a patient, or potential patient, when attempting to schedule an appointment with the provider indicates to the provider that he or she is seeking a specific health care service for which the provider has a conscience-based objection, the provider must notify the patient that he or she does not provide such service before scheduling the appointment. A health care provider who is a student must provide written notice of his or her conscience based objection to the educational institution at the time the conscience-based objection is made or as soon as practicable thereafter.

In the preceding section, a “health care service” was defined in a way that covered what appeared to be any conceivable form of medical care:

(g) “Health care service” means medical research, medical procedures, or medical services, including, but not limited to, testing; diagnosis; referral; dispensing or administering any drug, medication, or device; psychological therapy or counseling; research; therapy; recordmaking procedures; set up or performance of a surgery or procedure; or any other care or services performed or provided by any health care provider.

Discussion of the signed legislation understandably focused on the effects of the bill on emergency or situations where medical care is the difference between life and death; Caraballo linked to a Wikipedia entry about the 1995 death of Tyra Hunter following a car accident.

An April 10 2023 article by FloridaPolitics.com covered the then-pending bills, and mentioned a proposed amendment to the Florida House version of the bill, HB 1403:

Before agreeing to pass the bill, the committee tagged on an amendment making it clear the bill does not apply to emergency medical treatment or to the provision of life-supporting equipment that is “essential to the restoration or continuation of a bodily function important to the continuation of human life,” such as enteral feeding pumps or ventilator equipment and supplies.

Retired Department of Health physician Paul Arons said the legislation erroneously elevates physicians’ religious and moral beliefs above public health and said if passed it could jeopardize a policy passed in 1989 that requires physicians in Florida to treat patients with HIV and AIDS.

“An amendment” linked to a PDF copy of the proposed amendment, which read:

(6) EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR ACT.—

This section does not override the requirement to provide emergency medical treatment to all patients as set forth in the Emergency Medical Treatment and Active Labor Act, 42 U.S.C. s. 1395dd.

(7) LIFE SUPPORTING CARE. This section does not apply to medical treatments utilizing life-supporting or life-sustaining equipment as defined in s. 400.925.

We searched the version linked [PDF] in DeSantis’ press release for matching language. In it, the words “life,” “supporting,” and “equipment” did not appear. “Emergency” appeared three times, and a section of the version linked on May 11 2023 appeared to omit the language about life-supporting or sustaining treatments:

(6) REQUIREMENT TO PROVIDE EMERGENCY MEDICAL TREATMENT.—

This section may not be construed to override any requirement to provide emergency medical treatment in accordance with state law or the Emergency Medical Treatment and Active Labor Act, 42 U.S.C. s. 1395dd.

A viral May 13 2023 tweet by Alejandra Caraballo asserted that Florida Governor Ron DeSantis “just signed the ‘Let Them Die Act’ which allows medical professionals to refuse to treat patients, even if it puts their lives at risk”; in a follow-up tweet, Caraballo provided the name of the legislation.

DeSantis issued a May 11 2023 press release that confirmed he signed the legislation into law. The bill enabled any healthcare provider or payor to refuse to treat Florida residents on the basis of the entity’s purported beliefs. An early amendment excluding “life supporting care” did not appear in the version DeSantis linked, which held that a section “may not be construed to override any requirement to provide emergency medical treatment in accordance with state law or the Emergency Medical Treatment and Active Labor Act.”