Legislature(2003 - 2004)
02/18/2004 01:04 PM House JUD
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* first hearing in first committee of referral
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SB 30 - ABORTION: INFORMED CONSENT; INFORMATION [Contains mention that HB 292 might be incorporated into SB 30, companion bill to HB 292.] Number 0812 CHAIR McGUIRE announced that the final order of business would be CS FOR SENATE BILL NO. 30(JUD) am, "An Act relating to information and services available to pregnant women and other persons; and ensuring informed consent before an abortion may be performed, except in cases of medical emergency." [Before the committee was HCS CSSB 30(HES)]. CHAIR McGUIRE noted that SB 30 is the companion bill to HB 292, which has been heard previously by the House Judiciary Standing Committee. She relayed that individual testimony on SB 30 would be limited to 3 minutes, and asked that those who've spoken previously on HB 292 limit their testimony to new points rather than repeating their previous comments. Number 0701 SENATOR FRED DYSON, Alaska State Legislature, sponsor, relayed that since the last House Judiciary Standing Committee meeting he'd had a committee substitute (CS) created to address the concerns brought forward by a letter from the attorney general. He offered his understanding that Chair McGuire is also preparing a CS for SB 30, and remarked that because of the modifications in the committee substitutes, a title change was necessary. CHAIR McGUIRE shared that there was a title change resolution coming from Legislative Legal and Research Services, and it was her intent to further discuss SB 30 after the title change resolution had arrived. SENATOR DYSON suggested that both he and Chair McGuire explain the changes that their respective offices are proposing to SB 30. He said that some of the concerns from the testifiers may already be addressed in those changes. The committee took an at-ease from 2:30 p.m. to 2:32 p.m. CHAIR McGUIRE brought attention to the proposed House CS for SB 30, Version 23-LS0193\N, Mischel, 2/18/04. She asked Senator Dyson to explain the changes in Version N. Number 0201 JASON HOOLEY, Staff to Senator Fred Dyson, Alaska State Legislature, sponsor, explained, on behalf of Senator Dyson, Version N. He referred to the concerns brought forth from the attorney general's letter dated February 11, 2004. The first change in Version N deals with the concern stated on page 2 of the letter. Under Section 1 of [HCS CSSB 30(HES)], the letter points out that there are inconsistencies with the immunity language within the bill; Mr. Hooley stated that Version N has addressed this concern by adding immunity language to Section 4. MR. HOOLEY referring again to the attorney general's letter, he noted that it raises some concern about the potential psychological damages that might be incurred to women that are pregnant from rape or incest. He stated that on page 6, subsection (d), of Version N, the language has been added to exclude the requirement of informed consent to women that are pregnant due to rape or incest. He also relayed that because of the concern raised in the attorney general's letter, language has been added to page 3, lines 4-5, that addresses the issue of obtaining child support. REPRESENTATIVE GRUENBERG asked if the text concerning child support in [HCS CSSB 30(HES)] had been changed, adding that he felt that that language looked pretty good. Number 0324 MR. HOOLEY stated that the intent hadn't changed, but the language had been streamlined to say the same thing more clearly. He then referred to the attorney general's recommendation that the provision in [HCS CSSB 30(HES)] regarding showing pictures of unborn children in two-week gestational increments may be too graphic and burdensome. He stated that on page 3, paragraph (6), of Version N the provision has been changed from showing photos at two-week increments to showing photos at four-week increments, and the access to these photos would be by a link on the web site rather than on the web site itself. CHAIR McGUIRE clarified that the description of the fetal development is presented on the web site, but the photographs were available by a link if someone wanted to see them. MR. HOOLEY said that the attorney general pointed out in his letter that that the information relaying the risks and benefits of having an abortion, carrying a pregnancy to term, and contraceptives, may be found to be unconstitutionally vague. He said that because of this, the language had been aligned with the informed consent requirements in AS 18.16.060. CHAIR McGUIRE said that part of the attorney general's concern has been addressed in a CS that she will be proposing, in that it removes the section that refers to contraception and psychological or other harm. She said she felt that that information didn't need to be a part of SB 30, and relayed that on page 2, line 23, of Version N there is new language which she feels better handles the contraceptive options issues. TAPE 04-18, SIDE A Number 0001 MR. HOOLEY referred to the concerns raised on page 4 of the attorney general's letter that deals with the specific informational requirements that a doctor has to provide a woman before she has an abortion. He said that because of these concerns, language has been added that gives the doctor the ability to tailor the information provided to the woman based on the specific circumstances of her pregnancy. He offered that the doctor has the flexibility to use the information presented on the web site, or use appropriate information specific to the circumstances of the pregnancy if the web site information is not used. He pointed out that this new language is found on page 5, in subsection (b), paragraphs (1) and (2). CHAIR McGUIRE commented that she felt that this was a good addition to the bill, that doctors may have more information based on certain situations that they have witnessed and which the web site might not have access to. MR. HOOLEY noted that the attorney general mentioned that the provisions for parental consent and judicial bypass have recently been found unconstitutional. He stated that the sections dealing with these issues have been left in Version N, but a severability clause has been added if those things are found to be unconstitutional by the Alaska Supreme Court. He said that if those provisions need to be stricken from SB 30, it will have no effect on the rest of the bill. MR. HOOLEY again referred to page 4 of the attorney general's letter, the portion which raises the concern about the imposition of a 24-hour waiting period. He said that this concern is addressed in Version N on page 6, subsection (c), where the language has been changed to allow the information to be distributed by other means including fax, email, Internet, and standard mail. He stated that there is usually a one to three week time period between the initial contact and the actual procedure. He said that all the rural public health facilities have Internet access, which would enable those communities to access this information as well. Number 0279 CHAIR McGUIRE stated that the 24-hour waiting period seems to be one of the parts of SB 30 that is controversial. Stating that based on testimony that the House Judiciary Standing Committee has heard that there are no cases that an abortion has been performed within 24-hours of the initial consultation, Chair McGuire asked if this requirement is really solving a problem. SENATOR DYSON responded that he has received the same information regarding the amount of time that lapses between the initial consultation and the actual procedure. He said that it is his belief that the 24-hour grace period imposes no burden on the patient, provider, or process. He said that because no one knows what the future will bring, and based on the medical records and what people have seen over the last 40-50 years, he believes that this is a serious medical procedure. He said that with the current process, where there is a time lapse between the initial consultation and the procedure, that waiting period has proven to be beneficial. SENATOR DYSON stated that this issue has engaged him all of his adult life. He shared a story about when he was a member of the Anchorage Assembly and participated in protests and went to jail two separate times. He stated that one night while participating in the Anchorage Assembly meeting, a woman testified during the public comment section of the meeting that six months previous to that date, she was going to get an abortion. She'd told them that she saw the people protesting and getting arrested, and that some nice ladies came and talked to her. She'd said that those ladies informed her of the alternatives that she had available to her, and told her that she would have sources of support if she decided to carry her pregnancy to term. SENATOR DYSON stated that the woman had the baby with her while she was testifying. He stated that [the legislature] doesn't want to make laws based on anecdotes, but the time lapse that happened before this woman got an abortion proved to be extremely valuable. He commented that he found it hard to argue with the point that having a minimum amount of time to consider the information pertaining to [pregnancy options] would be beneficial. He stated that the child that the woman chose to carry to term was now 17 years old and goes to school in Alaska. Number 0547 SENATOR DYSON stated that [the legislature] doesn't know what technological advances in medical science will enable doctors to do in the future. He emphasized that because of the potential risks and consequences that could occur, he feels that having a waiting period is valuable. He said that he believes what makes abortion different than other medical procedures is that there is a human rights issue involved. He said that when human rights and life are involved, [the legislature] has an added burden and must be careful and be thoughtful of the decisions that are made, particularly about irreversible procedures. REPRESENTATIVE ANDERSON stated that he held the same concerns as Chair McGuire in regard to the 24-hour waiting period. He said his initial concern with passing SB 30 and maintaining the 24- hour waiting period was that very rarely, if ever, were there times when a woman could get an abortion within 24-hours of her initial visit. He noted that the attorney general stated that there is no other procedure where there is a mandatory waiting period, and that brings up equal protection issues. He said he wonders if it is necessary to keep that language in the bill, and if it is kept, would there be [equal protection] cases in the near future. He acknowledged the point, however, that in the future there may be advancements in technology that would speed up medical procedures and so it might be possible for a woman to receive an abortion within 24-hours of her initial consultation. SENATOR DYSON relayed that there were other states where a mandatory waiting period has been enacted, and it has stood up to legal challenge. MR. HOOLEY referred again to the attorney general's letter, stating that Version N addresses concerns raised about medical emergencies. He noted that on page 6, subsection (d), the language has been changed to clarify this issue. REPRESENTATIVE GARA asked about waiving the 24-hour waiting period requirement when the harm relates to a major bodily function of a woman. He stated that he thought it should be waived if there were any substantial risks to the health of a woman. Number 0868 SENATOR DYSON surmised that people who are familiar with the abortion issue will understand the subjective nature of the issues and that the language can be interpreted in more than one way. He said that language in Version N is attempting to be as objective as possible when talking about the physical problems that would allow waiving the 24-hour waiting period. He stated that there is language in the bill that also waives the mandatory 24-hour waiting period to get an abortion in cases of rape, incest, or if there is a medical necessity. REPRESENTATIVE GARA asked if Senator Dyson would be open to broadening the language to include a risk of significant injury [to the woman]. SENATOR DYSON stated that he would have to think about it, but he feels that would be agreeable. He stated that he doesn't want anyone to get hurt. CHAIR McGUIRE said she felt that Representative Gara made a good point, though she understands the balance that Senator Dyson is trying to achieve. She also said she felt that the language [in Version N] is a little too specific. REPRESENTATIVE ANDERSON suggested taking out "of a major bodily function of" from page 6, line 18, and inserting "to". CHAIR McGUIRE said that was a good suggestion and asked for a written version to be presented at the next hearing on SB 30. SENATOR DYSON stated that he wanted to go back and look at the history of that particular phrase, and the specific reasoning behind choosing it. CHAIR McGUIRE, after ascertaining that there were no immediate questions for Senator Dyson and Mr. Hooley, asked them to stay at the meeting to address issues later. SENATOR DYSON noted his appreciation for the cooperation that he has received from the attorney general's office, Legislative Legal and Research Services, and Representative Dahlstrom's office. He predicted that the final version of SB 30 will be excellent, adding that he appreciates all the effort put forth in its formation. Number 1048 VANESSA TONDINI, Staff to Representative Lesil McGuire, House Judiciary Standing Committee, Alaska State Legislature, relayed that she would be further explaining the changes in Version N. She said that there were two sections taken out of HCS CSSB 30(HES), one of them being on paragraph (9) on page 4. She said that that paragraph had been removed because Chair McGuire felt that the contraception information had been adequately addressed on page 2, subparagraphs (B) and (C) of Version N. She then relayed that the dated, time-stamped signature form described on page 4, paragraph (10), of HCS CSSB 30(HES) had been removed. She also noted that the only other changes were to Section 4 of HCS CSSB 30(HES) dealing with civil liability. CHAIR McGUIRE added that she felt that the changes regarding the civil liability provision were necessary because she has never seen a cause of action created without an ensuing harm. She stated that with the changes that have been made, there has to be some type of harm in order to warrant a civil action. MS. TONDINI clarified that in order for a doctor to prove that he/she obtained informed consent, instead of using the dated, time-stamped signature form, the doctor would have to present the written certification that is required under the bill. Number 1213 REPRESENTATIVE NANCY DAHLSTROM, Alaska State Legislature, testified in support of SB 30. She said that she has been working extensively on the companion bill, HB 292, and appreciates the effort that has gone into the development of these two bills. She asked the committee to move forward and pass SB 30 out of the House Judiciary Standing Committee. REPRESENTATIVE GRUENBERG asked Representative Dahlstrom if she was going to suggest any amendments for SB 30. REPRESENTATIVE DAHLSTROM stated that she and her staff have been going through Version N and haven't found anything thus far that would necessitate an amendment. She relayed, however, that she hasn't finished that process, but will continue to go through SB 30 and suggest any needed amendments. Number 1365 JENNIFER RUDINGER, Executive Director, Alaska Civil Liberties Union (AkCLU), stated that she'd just recently received a copy of Version N, so she hasn't been able to go over it as thoroughly as she'd like, though at this point she did have some concerns that she would like to present to the committee. For example, the AkCLU believes that Version N is still unconstitutional. She said that it is unfair to single out this one constitutionally protected choice and place hurdles in front of women who are seeking to exercise that choice. She referred to page 1, paragraph (1), where it states that this is a critical area of medical practice. She said that the AkCLU believes that this is where the bill is attempting to single out this procedure. She shared that she felt that this phrase is legally insufficient, and stated that the language should be removed to avoid privacy and personal protection problems. MS. RUDINGER noted that Version N removes language from the HCS CSSB 30(HES) that referenced circumstantial criteria - page 2, paragraph (3) - and said that the AkCLU wondered why that section was removed. Next, she cited page 3, paragraph (5), of Version N, where providing information regarding child support is mentioned, and noted that there are difficulties that exist in the reality of the process of collecting or enforcing child support; she indicated that this provision is necessary if the intention is to give women full information. She moved onto page 3, paragraph (6), where the information provided describes the fetal development of a typical, healthy fetus in two-week gestational increments. She stated that this information is not necessarily relevant to women who may have problem pregnancies. She also stated that although the graphic photographs would be accessible by a link instead of on the web site, there might be information at that link that is not relevant to the woman who is looking at it. Number 1537 MS. RUDINGER shared her concern with the removal of the requirement that all the information presented had to be reviewed by obstetricians and gynecologists designated by the State Medical Board. She opined that doctors are certainly in the best position to ensure the accuracy and objectivity of this information. She mentioned that on page 3, paragraphs (7) and (8), there are references to psychological effects, but opined that there has been no proof that psychological harm is incurred because of an abortion. She cited a 1987/1988 investigation by the former United States Surgeon General, DR. C. Everett Koop, whom she said was no champion of [pro-choice issues], and she cited a study from the World Health Association. In each of these cases, it was determined that there is no medical evidence that abortions cause psychological injury. She said that when women undergo a voluntary abortion, relief is the most common reaction. MS. RUDINGER said that the information provided to patients who want to have an abortion should be determined by doctors who are in the best position to assess the risks involved and the specific circumstances that are relevant. She then pointed out some incorrect definitions contained in SB 30. Specifically gestational age and the term "unborn child", which she said isn't even a medical term. She stated that she would let the doctors who are testifying speak more about these incorrect terms and definitions. MS. RUDINGER cited page 4, Section 4, and stated that the information dealing with liability and immunity is very vague. She pointed out that the only way for physicians to protect themselves is to use the information from the web site which has information that hasn't been reviewed for accuracy by obstetricians and gynecologists or by the State Medical Board. She said that the AkCLU feels that this liability section is very problematic. MS. RUDINGER shared that the AkCLU has the biggest issue with the 24-hour waiting period required by SB 30. She stated that the waiting period is unconstitutional, and emphasized that the attorney general and the AkCLU have pointed out to the legislature, every time an issue like this has been before it, that the waiting period is unconstitutional. She opined that the waiting period is a violation of equal protection, and noted that there is no other medical procedure for which a mandatory waiting period is imposed. She said this concludes her testimony, and thanked the committee for their latitude. Number 1656 CHAIR McGUIRE thanked Ms. Rudinger for her testimony, and explained that the State Medical Board had asked to be removed from reviewing the information on the web site. She said that the State Medical Board did not feel that reviewing the information was the appropriate purview for them mainly because it isn't their duty to review information. She clarified that the State Medical Board's duty is to spend time managing those doctors who do good and bad, and, if the doctors are doing bad, to protect the public from them. She further explained that the State Medical Board is voluntary, they only meet quarterly for a few days, and the members do not have enough time as it is to address the negligent doctor cases that exist. MS. RUDINGER stated that to avoid a future lawsuit, it will be important that the information on the web site be medically accurate. She stated that there is language within [Version N] that is medically inaccurate and that could create some problems in the future. Number 1728 DEBBIE JOSLIN, President, Eagle Forum Alaska, shared that she has been in a situation where she was pregnant and encouraged to get an abortion. She stated that she did have an abortion in 1976 and it was her experience that abortionists will see a patient, go through preliminary discussion, and within a half hour perform an abortion. She expressed her concern that the House Judiciary Standing Committee has suggested waiving the 24- hour waiting period for something as ambiguous as impairment to a women. Ms. Joslin stated that impairment could mean just about anything. She referred to her pregnancy in 1999, where she was encouraged to have an abortion and stated that it would be easy for a doctor to use any reason to waive the 24-hour waiting period and the informed consent and say that there was an impairment to the woman. MS. JOSLIN stated that setting up the law as proposed isn't taking into consideration what is happening to women in Alaska. She said that she feels that the legislature is aligning itself on the side of the abortion industry and not on the side of women. She shared that she believes that women do undergo psychological effects when they have an abortion. She referred to the comments from Ms. Rudinger where she referred to the investigation by Dr. C. Everett Koop. Ms. Joslin stated that although the investigation done in the late '80s found no medical evidence of psychological damage to a woman that has an abortion, there have been numerous studies since that do show psychological aftereffects in women after they have an abortion, adding that those effects aren't known immediately. MS. JOSLIN shared her concern regarding the removal of the photographs of the fetal development. She noted that there was discussion that a woman whose fetus had anomalies might look at a photo of a normal fetus and that would have no relevance to her situation. She stated that she had a child that had very serious fetal anomalies and seeing the photographs of a healthy fetus was very relevant to her. She said that by looking at the healthy fetal development, she could better grasp the status of the fetus developing inside of her. She felt that it was unfair for women to be denied access to these pictures just because there might be an abnormality in fetal development. MS. JOSLIN urged the committee to uphold the 24-hour waiting period and the requirement of informed consent for women who want to have an abortion in cases of rape or incest. She stated that the psychological effects of rape and incest are great, and to compound those effects by a woman undergoing an abortion, another traumatic experience where she is really being violated again, would be the wrong thing to do. She shared her concern that in the future, if these requirements are waived, that a woman will come back after an abortion and say "I wish you had told me the options, and I wish you had told me what the immediate and long term effects were of having an abortion, even though this wasn't by any means a planned pregnancy." Ms. Joslin thanked the committee. Number 1898 SARA CHAMBERS spoke in opposition to SB 30. She stated that she is a voter, a mother of a 16 week old son, and that as a woman of child-bearing age, she has given a great deal of thought to the pro-choice/pro-life debate. She shared that during her consideration of each side of the issue, one constant has remained: the belief that if a woman is informed of the medical consequences of her decision to terminate her pregnancy, she will make the decision against abortion. She stated that this belief is predicated by the concept of free, unforced access to unbiased information developed and governed by professional medical science. She stated that SB 30 and HB 292 do not meet these two criteria. She said that passing these bills would be dangerous because it would place the Alaska State Legislature in ultimate control over the medical information provided to the public. Ms. Chambers commented that the medical staff selected to serve on the governing board put forth by this legislation will ultimately be beholden to the legislature, and more disturbingly, the party that holds the majority at any given time. She stated that most of those people are not medical doctors. She said that she is further disturbed that there is no medical oversight in Version N. She shared her concern that enacting this legislation will coerce one small segment of the population into listening to this potentially biased advice. MS. CHAMBERS relayed that when she became pregnant a year ago, she had the opportunity to choose to receive medical care or not. She said that she could choose the level of medical care provided during her child's birth, at home, birthing center, or hospital. She pointed out that the state never contacted her to discuss her options, her prenatal care, or the health of the fetus. She stated that she was free to learn about her medical condition, just like every American. She said that she had the opportunity to consult a doctor, a free clinic, web sites, or books. She also stated that she had the option to do none of these things. She declared that SB 30 and HB 292 propose to discriminate between classes of pregnant women, which is an offensive, if not unconstitutional, practice. Ms. Chambers inquired why the state would want to spend funds to create a medical web site when many already exist. MS. CHAMBERS emphasized that these bills were redundant and a wasteful use of much needed public funds, especially in these times of fiscal crisis within Alaska. She conveyed her belief that there were more efficient ways to help Alaskan families than to create another web site offering government control [and] pseudo-medical advice. Ms. Chambers expressed her concern with the statement by any legislator supporting this legislation that he/she believes it is acceptable for government to force its citizens to receive biased government advice on any medical procedure. She stressed that this is not the role of government, and she finds it frightening that there are legislators who want to place what should be a private discussion between a doctor and patient under public duress. Number 2035 MS. CHAMBERS commented that this is a slippery slope, and she urged the legislators to think about the message and consequences of these bills before they vote. She stated that SB 30 and HB 292 are dangerous proposals because they would force Alaskans to listen to biased information that isn't rooted in science, but party politics. She reiterated that these bills were a waste of public funds, and they place the legislators between a patient and a doctor or other freely chosen medical professional. She then urged the committee to vote against SB 30 and HB 292. REPRESENTATIVE GARA commented that the pro-life/pro-choice debate is one that doesn't involve industries that would come in and try to garner support by spending money. He pointed out that it was a debate with public citizens on both sides, and that it was a wrenching debate. He stated that he took exception to the comment made be Ms. Joslin referring to the "abortion industry"; he reiterated that the people who participate in the abortion debate tend not to be people that are throwing money at the issue. He offered his belief that the people who align themselves with the pro-choice side do not make a lot of money [on this issue]. CHAIR McGUIRE mentioned that reference to the State Medical Board ought to be put back into SB 30 because she wasn't sure if there was a way to have unbiased, medically accurate information if it just came from the government. Number 2103 COLLEEN MURPHY, M.D., Obstetrician/Gynecologist (OB/GYN), shared that she has been a doctor since 1981, came to Alaska in 1987, and is an abortion provider. She stated that she had performed three abortions today and a follow up, so she knows the procedures that are involved with abortions. She commented that SB 30 represents an anti-privacy movement. She said that she doesn't use the terms pro-life or pro-choice anymore because the real issue deals with privacy. She emphasized that she is a multi-year member of the Alaska State Medical Association's Legislative Subcommittee, and relayed that this subcommittee examines different bills that are of medical interest. She stated that the subcommittee has taken an opposing position to SB 30 because of the manner in which it disrupts the patient/provider relationship and inserts the government into that care. DR. MURPHY shared that she had recently been discussing a bill that the Alaska State Medical Association and Alaska Physicians and Surgeons, Inc., are working on in effort to produce caps on non-economic damages as it relates to medical malpractice. She stated that she isn't too familiar with that bill, but she does know that there is information pertaining to informed consent. She emphasized that SB 30 is redundant, and it focuses on a very specific aspect of health care. She expressed her view that SB 30 was discriminatory against women seeking a particular health care option. She suggested that SB 30 was a very exhaustive exercise that would be challenged in the court system to a considerable extent because of the repetitive parallels that are present in the bill that have been involved in previous court cases and been struck down. DR. MURPHY indicated that she would be available for any questions and expressed that the 24-hour waiting period for an abortion proposed by SB 30 has no medical basis. She commented that she thought the 24-hour waiting period is obstructive and she felt that SB 30 is an attempt to create barriers for women attempting to have an abortion. In conclusion, she reminded the committee that the number one cause of death relating to maternal mortality, before Roe v. Wade in 1973, was illegally performed abortions. CHAIR McGUIRE thanked Dr. Murphy for her testimony and pointed out that she has included [in a forthcoming proposed CS] the exact language from the bill dealing with medical malpractice that Dr. Murphy had mentioned. Chair McGuire relayed that a previous version of SB 30 created a cause of action without having any harm done at all, just failing to provide informed consent, and that has been changed in Version N. Number 2251 DR. MURPHY stressed that SB 30 is totally inappropriate for a woman that comes in for new OB care. She referred to a woman who came in at nine weeks of pregnancy and was diagnosed with twins. She stated that what she should do, according to the concept embodied in SB 30, is wait 24 hours and confirm that the woman wants to continue with her pregnancy because the woman with twins has a 40 percent chance of pre-term labor, a higher risk of malformations, twice the risk of genetic abnormalities, twice the risk of preeclampsia, and a much higher rate of caesarian section. Dr. Murphy remarked that despite all of these potential risks, she didn't wait 24-hours to treat her patient. She used this example as a reason that the 24-hour waiting period makes no sense for any form of health care. DR. MURPHY commented that access to health care in Alaska is horrendous, and in particular, access to abortion clinics is only available in major population centers. She observed that women who seek abortions must now take time off work and displace themselves. She stated that an additional 24-hour waiting period is not necessary or cost-effective. She reiterated that enacting the waiting period is discriminatory because there is no other medical procedure that is subject to the travails that are suggested by SB 30. She pointed out that these steps are only applied to women and there are parallels between this proposition and contraceptive equity and health care needs that women require. DR. MURPHY referred to tort reform, stating that this issue is much larger than abortion. She stated that informed consent needs to be guaranteed for every type of health care need and consultation that is delivered. She expressed that this issue should not be micromanaged, especially by people that are not involved with health care. CHAIR McGUIRE asked Dr. Murphy if there are situations when a woman will decide to have an abortion, come in for her initial consultation, and have the abortion on the same day. DR. MURPHY stated that the majority of abortion procedures can be offered on the same day. She shared that this is how she currently offers her health care. She explained that generally patients will call a hotline or look up the information about an abortion online. She noted that she asks every woman who comes into her clinic how they heard about her services. [Not on tape, but taken from the Gavel to Gavel recording on the Internet, was: She stated that usually they have used one of these outside resources and thought long and hard about their decision to either follow through with the pregnancy, adopt the child out,] or terminate their pregnancy. TAPE 04-18, SIDE B Number 2393 DR. MURPHY commented that the amazing thing about women seeking abortion services is that the woman is thinking about what she needs. She shared her opinion that in this society, a woman is not allowed to consider her own needs first. She hoped that this was a sobering thought for the audience to think about, for a woman to actually think about what she needs [when she is pregnant] for the next nine months to one year in terms of what she is able to tolerate in her life and what she can do. Dr. Murphy stated that this is a psychosocial issue, where women are not allowed to put their needs first. Dr. Murphy stated that by the time a woman presents, there is no benefit to waiting; by such time, a woman is already feeling the effects of her pregnancy and wants to move on and use an effective form of family planning. REPRESENTATIVE GARA asked if one of the burdens of the 24-hour waiting period is that it forces women who come from rural areas to stay an extra day away from their home. DR. MURPHY stated that was absolutely true. She said that 88 percent of all counties in the United States do not have abortion services available, so women must travel anywhere from 50 to 150 miles to seek termination services. REPRESENTATIVE GARA asked Dr. Murphy, based on the informed consent section in SB 30, what information she would provide to women who decide to carry their pregnancy to term. DR. MURPHY responded that she alluded to this when talking about the woman that had conceived twins. She went on to add that the woman already has two children, ages one and two, and one of those children has neurofibromatosis, also known as elephant man's disease, and that there is concern that the twins she is carrying may have the same condition. Dr. Murphy stated that in Afghanistan the average woman has eight children and the mortality rate for those children is 50 percent. She stated that the United States takes [infant mortality] for granted because it has a relatively low "parity state". DR. MURPHY also noted that in Ethiopia, 1 in 25 women die during childbirth. She commented that there are complications that could happen with carrying a pregnancy to term in the United States, and she talks with her patients as a conscientious board certified professional medical provider and doesn't need legislation to tell her how to take care of pregnant women. She added that Cuba has a lower infant mortality rate than the United States and they spend a lot less money on their medical system. She opined that lay people can trust the medical community because it has a lot of oversight. Number 2193 REPRESENTATIVE GARA ascertained that one of the consequences of SB 30 would be that medical practitioners would have to discuss all of these issues with every woman that decides to carry her pregnancy to term. He then asked for some documentation that would illustrate the explanations that those women will receive from the doctors under SB 30. DR. MURPHY stated that many people expect the "perfect child" with every pregnancy, that technology will save all. She commented that even in the best instances, that possibility is not reasonable. She shared that a lot of lawsuits originate because people expect to have no complications during their pregnancy. She relayed that she has 40-45 books related to healthcare and isn't sure how she could distill it into a short document. REPRESENTATIVE GARA responded that he would like to get something that is about a page and a half long, but if she couldn't create something like that, then not to worry about it. DR. MURPHY referred him to the American college of OB/GYN web site that would provide the information that he was inquiring about and the standards that she has to adhere to. CHAIR McGUIRE thanked Dr. Murphy for her testimony. Number 2139 ROBERT JOHNSON M.D., began his testimony with his definition of the task of the legislature. He said that the legislature's task is to protect the right of the individual to engage in whatever activity he/she pleases, as long as there is no harm to anyone else. He added that it is not the business of legislators to restrict or limit individual choice, or to determine what is or isn't morally right or wrong. He said that abortion bills do both of these things. DR. JOHNSON stated that he felt the issue of abortion was an important enough subject for each of the committee members to consider his expert opinion. He added that the committee has been exposed to a number of lay opinions. Dr. Johnson explained that he is retired and has nothing to gain from his testimony against SB 30. He clarified that his purpose for testifying is to prevent obstacles being placed before women who, for a variety of reasons, need an abortion. DR. JOHNSON said that SB 30 would not only limit the options for women who seek an abortion, but also the physicians who would choose to provide the service. He commented that use of the term "unborn child" is declaring the fetus a person, and pointed out that this has not yet been determined. DR. JOHNSON explained that he was a physician in Kodiak before the passage of Roe v. Wade, and that at that time, women who became pregnant and did not want children had no alternative. He said that unwanted children faired poorly, many were abused, and most became wards of the state. He shared that he applauded the passage of Roe v. Wade, and noted that it was quickly adopted by the state, which, he opined, indicated that it was sorely needed. DR. JOHNSON informed the committee that he has done approximately 700 abortions, and his experience does not support many of the problems that many of those who oppose the procedure would lead others to believe occur. He said that his experience with abortion is not exceptional, and each of his patients was presented with options available to them in addition to the abortion. He stated that each patient was told as much as they wanted to know about the procedure, including the risks and the outcome. He noted that each patient had a follow up visit two- weeks after the procedure. DR. JOHNSON disclosed that only two of his patients developed post-abortion depression that required treatment, noting that this was less than the incidents of post-partum depression. He stated that both of those patients recovered from their post- abortion depression. He shared that none of his patients lost enough blood during the abortion to require a transfusion; only two patients had minor post-abortion infections and those responded promptly to treatment. Dr. Johnson emphasized that those women who had an abortion and later desired to have a child went on to have normal pregnancies. He said that he found no fertility problems associated with having an abortion. Number 2061 DR. JOHNSON shared his opinion that there is no indication for this type of legislation. He said that legislators have no business telling patients what they must know, what advice they receive, or from whom they receive the advice. He stated that it is an insult to the intelligence of a woman who, in his opinion, knows exactly what she wants to have information about and will make sure that her physician provides her with that information. He offered the question, "Do you think that physicians are not familiar with their responsibility to explain the options, risks, benefits, and procedures of any treatment?" He stated that SB 30 would place more obstacles in the path of those who need an abortion. He expressed that this bill, along with the issue of cost, complicates the decision and is intended to make women who elect to have an abortion feel guilty. Dr. Johnson cited that there are occasional suicides after a woman has an abortion and he felt that they were directly related to this point. DR. JOHNSON asked the committee if they felt that anyone had the right to make a decision for others regarding their choice. He asked if anyone should have the right to set up rules and procedures to serve as an impediment for another's exercise of choice. He asked if anyone should have the right to determine what is, or is not, morally right for someone else. In the name of compassion for women who cannot manage to bear or raise a child for whatever reason, Dr. Johnson implored the committee to reject SB 30 and any legislation that has to do with abortion. Number 1937 AMY BOLLENBACH stated that she agrees with both Dr. Johnson and Dr. Murphy and doesn't think that SB 30 is needed. She said that if the legislature is going to pass SB. 30, the term "unborn child" needs to be removed because it is not a medical term. She said that the 24-hour waiting period needs to be removed as well. She pointed out that transportation is very difficult in Alaska and so adding the 24-hour waiting period is an attempt to put another obstacle before women who want to have an abortion. She stated that if a minor wants to get an abortion, she must first get a judicial review, parental consent, and take other steps just to be permitted to have it. She said she feels that sometimes abortions need to be done quickly, and when someone is staying in a hotel for that specific reason, that is one of those times. MS. BOLLENBACH reminded the committee that many of the women and girls who are going to have an abortion will be living in remote villages, and noted that there are girls who need to get an abortion because they have been abused in their home. Many of these girls may not have a telephone in their home, and the only access they may have to a computer will be at school. She added that many have to travel long distances to Anchorage or another city just to be able to get the procedure done. She asked the committee not to add another hurdle to women seeking an abortion. Number 1865 ROBIN SMITH spoke in opposition to SB 30 and HB 292. She referred to the letter from the attorney general dated February 11, 2004, where he stated that HB 292 and SB 30 will have legal problems and may not be able to survive a constitutional challenge. She stated that the way she understood it now is that SB 30 failed to address the 24-hour issue and continued to include the parental consent judicial bypass issue. She added that according to the attorney general, there are also other issues beyond that. She observed that because of these issues, the bill before the committee still raises several constitutional concerns. MS. SMITH shared her opinion that over the last decade the legislature has insisted on passing bills that they know are unconstitutional. She stated that these laws end up getting challenged in court and eventually get turned down. She stated that four court cases have resulted in hundreds of thousands of dollars of state money being wasted. She commented that in this time of major financial cutbacks and a huge fiscal gap, the people of Alaska will be very upset to have more money wasted in this way. MS. SMITH urged the members to keep SB 30 and HB 292 within the committee until they have an opinion from the attorney general that the bills will survive constitutional scrutiny. CHAIR McGUIRE thanked Ms. Smith for her testimony and informed her that the committee would be asking the attorney general to look over Version N and any forthcoming proposed committee substitutes. MS. SMITH thanked Chair McGuire and said that it is really important to her that the committee not move the bill out if it thinks the bill is unconstitutional, adding that it is a waste of the people's money. She stated that [wasting money on unconstitutional bills] has happened time and time again and she would hate to see it happen again with the current financial crisis facing Alaska. Number 1735 PAULINE UTTER urged the committee to not pass SB 30 or HB 292. She opined that Dr. Johnson and Dr. Murphy eloquently stated the reasons for not allowing the passage of these bills. CHAIR McGUIRE stated that she was going to close testimony today, but the committee would take written testimony; written testimony could just be e-mailed and will get distributed to the committee. She stated that the next time the committee hears SB 30, the new letter from the attorney general with his recommendations for the bill will also be available as well. She reiterated that after today, she will be limiting public testimony to written testimony. She also reiterated that there is a title change resolution forthcoming. Number 1653 CATHY GIRARD stated that it is unethical for the legislature to interfere in such a private and personal matter regarding a woman's decision to bring a pregnancy to term. She added that imposing a schedule on the choice to terminate a pregnancy is insulting to Alaskan women, Alaskan families, medical professionals, and spiritual communities; all of the aforementioned will undoubtedly have a role in that woman's ultimate decision regarding whether or not to bring a pregnancy to term. She related her own decisions regarding reproductive issues, stating that she never considered that the legislature would participate in her decision making process. She noted that she is an Alaskan woman, and is testifying that she does not need the legislature's help in making her own reproductive decisions. MS. GIRARD said that SB 30 does not address the values and morality of all Alaskan woman, and certainly does not address her own personal values or her morality whatsoever. She commented on some of the previous testifiers' statements focusing on the psychological impact of abortion on women. She stated that SB 30 is quite misguided and insulting to women because it presumes that women have not given significant thought to the entire situation in the first place. She shared that the women that she has known that have had abortions are definitely saddened at the thought that they have put themselves in the position of needing an abortion. She said that when she asked these women if they wished that they had made a different choice, the answer is very clear; abortion was absolutely the right choice given the situation that they were in at the time. She said that everyone makes decisions that they look back and reflect upon with sadness, but to think that women have been psychologically scarred by an abortion is certainly not true of all women. MS. GIRARD referred to the assertion that doctors are misguiding their patients by having a lack of information about all of the options available. She stated that patients often follow up with doctors because the patients have used the information that the doctors have provided. She referred to a shoulder surgery that she'd recently had, acknowledging that shoulder surgery is in no way like having an abortion, and stated that she got a second opinion because she didn't feel the information that she received from the first doctor was adequate for her to make an informed decision on what she wanted to have done with her shoulder. She said that she struggled with whether or not she wanted to have this invasive surgery, but ultimately she made her own decision as to what she wanted to happen to her body. She emphasized that this decision should be private regardless of whether it is something as unemotional as a shoulder, or as emotional as it can be when dealing with an abortion. MS. GIRARD stated that the access to information is a two-way street; if a patient is not getting information, and there certainly is a lot of information out there, then he/she needs to be more forthcoming in asking the doctor to provide more information. She said that the patient could also move on to other doctors until satisfied with the information received. She opined that doctors already know about their legal obligations to provide a full-scope of information before a procedure of any type is offered to a patient. She referred to Dr. Murphy's testimony that SB 30 would only get in the way of a practice that is already in effect. Ms. Girard opined that passing SB 30 is redundant and unnecessary. MS. GIRARD then pointed out to the committee that the [Alaska State Medical Association (ASMA)] is also against SB 30 because it believes that the services it provides are already adequate, and said she feels that to be true. She stated that if a patient feels that they are not receiving adequate information, they need to find a practitioner that is right for them. Ms. Girard added that an unplanned pregnancy is an extremely emotional experience that cannot be characterized by stereotyped feelings. MS. GIRARD said she accepts that the woman that Senator Dyson referred to in his earlier testimony is glad that she made the right decision for herself. However, Ms. Girard expressed that a 24-hour waiting period is no guarantee that a light bulb is going to go off in a woman's head and totally change her decision-making process. She explained that a long, hard decision-making process has already occurred before a woman shows up in a doctor's office, and it isn't up to the legislature to make that decision for a woman anyway. Number 1411 ROMA KOTTE, Student, University of Alaska Fairbanks, testified in support of SB 30 as part of a school project. She said that SB 30 made good sense because it encourages people to thoroughly think out a decision that will (indisc.) Turning attention to Section 5, subsection (d)(2), of Version N, and the suggested change to remove "of a major bodily function of" and replace it with "to", she opined that this change would open up [the definition of] impairment to include any psychological and emotional impairment that could come from not being able to have an abortion. MS. KOTTE, contrary to Representative Gara's comment that people who align themselves with the pro-choice side do not make a lot of money by performing abortions, offered her belief that the abortion industry is a multi-million dollar industry and does make a considerable amount of money by performing these services. MS. KOTTE referred to Dr. Murphy's testimony. She said that Dr. Murphy was encouraging the thought that it was okay to be selfish in America. She stated that it is a very scary society when people encourage others to be selfish and to not think about the common good of others. She continued to refer to Dr. Murphy's testimony and stated that Dr. Murphy used extreme examples, such as women in Afghanistan who die during childbirth, and the woman who had twins with elephant man's disease. Ms. Kotte stated that anyone could use extreme examples but, in truth, many of the abortions that are occurring today are being done to healthy babies. Number 1297 CAREN ROBINSON, Lobbyist for Alaska Women's Lobby, stated that the Alaska Women's Lobby is strongly opposed to SB 30. She said that the bill may be rewritten or redrafted, but it is currently unconstitutional. She said the best way to ensure that women get good information is to continue with the education process through doctors and web sites, but not need to this extreme. Ms. Robinson shared that she moved to Juneau from Texas in 1976, when abortion services were not readily available. She stated that the legislature doesn't understand the consequences that women in rural areas and places that do not have abortion services have to go through. She stated that in order to get an abortion, a woman must first go to a doctor in her area before she can go to a place where abortion services are provided. MS. ROBINSON said that after that initial doctor visit, women have to take their information to yet another doctor to get an abortion. She stated that many times women have to buy tickets to Seattle or Anchorage, and that is very costly. She used these examples to illustrate that women have already evaluated their situation and made a decision before they have left their home to seek out abortion services. She stated that adding an extra 24-hour waiting period to this process makes no sense. MS. ROBINSON referred to her growing up in Texas when abortion was not legal, stating that women had to go to California or Mexico, where the situation was dangerous, to get an abortion done. She commented that she doesn't think that this is the direction that the legislature is trying to go towards, but the information should be left up to the doctors, nurses, and other professionals that women go to, to obtain the information that they desire before making their decision. Ms. Robinson stated that [in situations like these], very few women make their decision on a whim. She noted that she has friends that are coming in contact with the children that they had put up for adoption years ago. She stated that it was important for women to have the right to make those kinds of choices, and not be burdened by the types of decisions that SB 30 would put in place. She expressed her appreciation for all the time and effort that has gone into forming SB 30, but added that she feels the committee should table the bill and allow the current process to continue. Number 1103 CHAIR McGUIRE thanked Ms. Robinson for her testimony and added that she was not around when abortions were illegal, but her father was a physician that practiced medicine during that time. She stated that abortion was definitely an emotional issue, and assured Ms. Robinson that the committee was not proposing to go back to that time period. She clarified that the committee is trying to decide if there is an appropriate role the legislature should take in providing women with information. She stated that there are well meaning people on both sides of the issue, but there is also misinformation on both sides. She acknowledged that one of the arguments against SB 30 is that doctors are already providing the information and are already required, by medical malpractice [insurance] providers, to obtain informed consent from patients. She stated that there is a regulation on the books that requires informed consent before providing an abortion, and noted that the State of Alaska has treated abortion differently than other types of procedures. She then thanked Ms. Robinson for her very personal and thoughtful testimony. MS. ROBINSON stated that she was a member of the House Judiciary Standing Committee in 1996, so she understands the difficult decisions that the committee has to grapple with. She expressed that she was very fortunate to have a son and grandchildren, and stressed that it is very important that both men and women get good information and help to be good parents. She shared that it is important to put money into programs like the Denali Kid Care program, which she feels is extremely successful, and said programs like that are worth investing in because they truly give people choices. Number 0939 CHAIR McGUIRE, noting that there were no further witnesses, closed public testimony on SB 30. She stated that she would be happy to take any written testimony that anyone has to offer as a result of the changes that would come about with the new version of SB 30. She reiterated that the committee is still awaiting the attorney general's opinion on Version N, and that she expects some further amendments to be made. She said that the committee is moving slowly so that the people that are interested could keep in touch. She then thanked everyone for his/her testimony. [SB 30 was held over.]
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