Texas may require medical records list patients’ sex assigned at birth

Sign up for The Brief, The Texas Tribune’s daily newsletter that keeps readers up to speed on the most essential Texas news.

---

The Texas House on Thursday approved a bill requiring health agencies to create a new field in medical records for the sex assigned at birth of patients and strict oversight and punishment of health care providers who change records.

Senate Bill 1188 encompasses “multiple components” according to the bill’s sponsor, Rep. Greg Bonnen, R-Friendswood, including restrictions on health care providers’ storage of digital servers and their use of artificial intelligence. Democratic legislators on Thursday, however, largely zeroed in on a provision requiring all health records to include a new segment explicitly listing the sex a patient was assigned at birth and any physical sexual development disorders they may have.

SB 1188 is one of several bills moving through the Legislature aimed at restricting the health care of trans Texans, however SB 1188 does have an exemption stating it does not restrict gender identity information from being included in health records. To enforce its provisions, SB 1188 allows the attorney general to file for injunctions against violations of the bill, and would create penalties of up to $250,000 for practices who knowingly violate its provisions. The bill allows for gender markers to be changed for clerical errors or in certain cases for intersex patients.

Democratic lawmakers who spoke in opposition of the bill said the required reporting of gender assigned at birth excludes transgender and intersex patients who may be forced to have a gender displayed in their medical records they don’t identify as.

“Knowing that documentation choices could trigger a government investigation discourages providers from recording accurate individualized information, especially in complex cases involving gender or sex variation,” Rep. Ron Reynolds, D-Missouri City, said. “It places fear and legal exposure ahead of best medical practice.”

Bonnen provided rebuttals for all of the proposed amendments and ensured opponents of the bill that it would help physicians understand a more complete picture of a patient’s medical history. Democratic representatives attempted to derail the bill down through two points of order and then brought a slew of amendments to the floor seeking to blunt some of the bill’s requirements, but were unsuccessful.

“Listen, biological sex and medical records is an issue of accuracy, and impacting safe medical care in an acute situation, an emergency could lead to a misdiagnosis,” Bonnen said. “The whole point of the section of the bill is to ensure the physicians always know the true biological sex from birth, and the language is carefully crafted to allow for exceptions based on other medical conditions.”

Bonnen provided his own amendment to the bill expanding the eligibility for those who could be listed as intersex and explicitly stating the bill does not ban AI use by medical professionals.

The bill outlines in statute its own definitions of several medical terms including “sexual development disorder,” male and female. While its definition of female matches that of House Bill 229 — a bill seeking to define male and female across state statute that passed in the House in May — it differs in its definition of what a male is. HB 229 defines a male as someone whose biological reproductive system “is developed to fertilize the ova of a female,” different from SB 1188’s requirement that male systems are “developed to produce sperm.”

Beyond its requirements on reporting biological sex, SB 1188 also gives parents and guardians of minors “unrestricted access” to the child’s medical records unless a court order is in place preventing them from doing so. The bill also requires medical professionals to disclose when they use artificial intelligence for diagnoses and review all AI-created documents.

The bill requires one more formal vote in the House, after which it will be sent for approval from the Senate as amended, then will head to Gov. Greg Abbott’s desk for his signature.

---

First round of TribFest speakers announced! Pulitzer Prize-winning columnist Maureen Dowd; U.S. Rep. Tony Gonzales, R-San Antonio; Fort Worth Mayor Mattie Parker; U.S. Sen. Adam Schiff, D-California; and U.S. Rep. Jasmine Crockett, D-Dallas are taking the stage Nov. 13–15 in Austin. Get your tickets today!