Legislature(1999 - 2000)
03/21/2000 03:04 PM HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE March 21, 2000 3:04 p.m. MEMBERS PRESENT Representative Fred Dyson, Chairman Representative Jim Whitaker Representative Joe Green Representative Carl Morgan Representative Tom Brice Representative Allen Kemplen Representative John Coghill MEMBERS ABSENT All members present COMMITTEE CALENDAR HOUSE BILL NO. 416 "An Act relating to insurance coverage for prostate cancer screening." - MOVED HB 416 OUT OF COMMITTEE SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 329 "An Act relating to services and information available to pregnant women and other persons; and requiring informed consent and a 24-hour waiting period before an abortion may be performed unless there is a medical emergency." - HEARD AND HELD HOUSE BILL NO. 256 "An Act relating to reports of suspected child abuse or neglect, and requiring that, as part of the investigation of the reports of suspected child abuse or neglect, all official interviews with children who are alleged to have been abused or neglected be recorded." - SCHEDULED BUT NOT HEARD PREVIOUS ACTION BILL: HB 416 SHORT TITLE: PROSTATE CANCER SCREENING Jrn-Date Jrn-Page Action 2/16/00 2222 (H) READ THE FIRST TIME - REFERRALS 2/16/00 2222 (H) L&C, HES 3/17/00 (H) L&C AT 3:15 PM CAPITOL 17 3/17/00 (H) Moved CSHB 416(L&C) Out of Committee 3/20/00 2610 (H) L&C RPT 3DP 2NR 3/20/00 2610 (H) DP: BRICE, CISSNA, ROKEBERG; 3/20/00 2610 (H) NR: MURKOWSKI, HALCRO 3/20/00 2611 (H) INDETERMINATE FISCAL NOTE (ADM) 3/20/00 2611 (H) ZERO FISCAL NOTE (DCED) 3/20/00 2619 (H) FIN REFERRAL ADDED 3/21/00 (H) HES AT 3:00 PM CAPITOL 106 BILL: HB 329 SHORT TITLE: INFO AND INFORMED CONSENT FOR ABORTION Jrn-Date Jrn-Page Action 2/02/00 2064 (H) READ THE FIRST TIME - REFERRALS 2/02/00 2064 (H) HES, JUD, FIN 2/04/00 2104 (H) COSPONSOR(S): KOHRING 2/09/00 2156 (H) COSPONSOR(S): DYSON, OGAN 2/16/00 2207 (H) SPONSOR SUBSTITUTE INTRODUCED 2/16/00 2207 (H) READ THE FIRST TIME - REFERRALS 2/16/00 2207 (H) HES, JUD, FIN 2/16/00 2207 (H) REFERRED TO HES 3/21/00 (H) HES AT 3:00 PM CAPITOL 106 WITNESS REGISTER MICHAEL H. MILLER 6737 Gray Street Juneau, Alaska 99801 POSITION STATEMENT: Testified in support of HB 416. DR. PETER NAKAMURA, Director Central Office Division of Public Health Department of Health & Social Services PO Box 110610 Juneau, Alaska 99811 POSITION STATEMENT: Answered questions on HB 416 and testified on HB 329. GORDON EVANS, Lobbyist Health Insurance Association of America 211 Fourth Street, Suite 305 Juneau, Alaska 99801 POSITION STATEMENT: Answered questions on HB 416. REBECCA HOWE PO Box 6211 Sitka, Alaska 99835 POSITION STATEMENT: Testified against HB 329. SANDY DORAN HC 31, Box 5213B Wasilla, Alaska 99654 POSITION STATEMENT: Testified in support of HB 329. EILEEN BECKER Director Homer Crisis Pregnancy Center PO Box 2 Homer, Alaska 99706 POSITION STATEMENT: Testified in support of HB 329. ALEATHA MARTIN 1540 Scenic Loop Fairbanks, Alaska 99709 POSITION STATEMENT: Testified in support of HB 329. REXANN BASSLER 13100 Badger Lane Anchorage, Alaska 99516 POSITION STATEMENT: Testified on HB 329. KAREN VOSBURGH, Executive Director Alaska Right to Life PO Box 1847 Palmer, Alaska 99645 POSITION STATEMENT: Testified on HB 329. HEIDI LIVENGOOD PO Box 750811 Fairbanks, Alaska 99775 POSITION STATEMENT: Testified on HB 329. ROZ JENKINS, Chairperson Advisory Council Planned Parenthood of Alaska, Sitka clinic 5 Maksoutoff Drive Sitka, Alaska 99835 POSITION STATEMENT: Testified on HB 329. DR. NELSON ISADA 3300 Providence Drive Anchorage, Alaska 99508 POSITION STATEMENT: Testified on HB 329. KARL ASHENBRENNER Juneau Pro-Choice Coalition Member, Alaska Pro-Choice 6013 Pine Street Juneau, Alaska 99801 POSITION STATEMENT: Testified against HB 329. DEBBIE JOSLIN PO Box 377 Delta Junction, Alaska 99737 POSITION STATEMENT: Testified on HB 329. WENDY S. CLOYD 2148 Old Steese Highway Fairbanks, Alaska 99712 POSITION STATEMENT: Her written testimony in support of HB 329 was read into the record by Danielle Serino, Staff to Representative Coghill. ANN HARRISON 3270 Rosie Creek Road Fairbanks, Alaska 99775 POSITION STATEMENT: Testified against HB 329. DAWN HOOKS 1324 Chirikof Court Anchorage, Alaska 99507 POSITION STATEMENT: Testified in support of HB 329. RUBY FLETCHER PO Box 521111 Big Lake, Alaska 99652 POSITION STATEMENT: Testified in support of HB 329. DR. COLLEEN MURPHY 2811 Illiamna Anchorage, Alaska 99517 POSITION STATEMENT: Testified against HB 329. RUTH EWIG 2325 30th Avenue Fairbanks, Alaska 99701 POSITION STATEMENT: Testified on HB 329. MARVELLE WILLIAMS 1930 Stonegate Circle Anchorage, Alaska 99515 POSITION STATEMENT: Testified in support of HB 329. CATHY GIRARD 2907 West 35th Anchorage, Alaska 99517 POSITION STATEMENT: Testified against HB 329. KATHERINE DAVEY 4880 New Castle Way Anchorage, Alaska 99503 POSITION STATEMENT: Testified against HB 329. ROBIN SMITH 14100 Jarvi Anchorage, Alaska 99515 POSITION STATEMENT: Testified against HB 329. JOYCE LAINE 3705 Arctic, Number 2045 Anchorage, Alaska 99503 POSITION STATEMENT: Testified against HB 329. JENNIFER RUDINGER, Executive Director Alaska Civil Liberties Union PO Box 201844 Anchorage, Alaska 99520 POSITION STATEMENT: Testified against HB 329. LAVERNE PETTIGER 6742 Stella Place Anchorage, Alaska 99507 POSITION STATEMENT: Testified in support of HB 329. LEILA WISE Alaska First Choice Alliance PO Box 244034 Anchorage, Alaska 99524 POSITION STATEMENT: Testified against HB 329. HUGH FLEISCHER 1401 West Eleventh Avenue Anchorage, Alaska 99501 POSITION STATEMENT: Testified against HB 329. CAREN ROBINSON, Lobbyist Alaska Women's Lobby PO Box 33702 Juneau, Alaska 99803 POSITION STATEMENT: Testified against HB 329. ACTION NARRATIVE TAPE 00-32, SIDE A Number 0001 CHAIRMAN FRED DYSON called the House Health, Education and Social Services Standing Committee meeting to order at 3:04 p.m. Members present at the call to order were Representatives Dyson, Whitaker, Green, Brice and Coghill. Representatives Kemplen and Morgan arrived as the meeting was in progress. HB 416 - PROSTATE CANCER SCREENING CHAIRMAN DYSON announced the first order of business as House Bill No. 416, "An Act relating to insurance coverage for prostate cancer screening." Number 0062 MICHAEL H. MILLER came forward to testify in support of HB 416 and read the following testimony: I am an advanced prostate cancer patient and a prostate cancer advocate. I became a four-year survivor of prostate cancer on January 17, 2000. At the time of my diagnosis in 1996, I was given 17 to 35 months to live. An aggressive clinical trial program has enabled me to be here today to urge your support for HB 416. (However, I must say I've had some side effects through a program that involved a drug called Suramin, and I've lost hearing in my right ear, and I'm wearing the sunglasses because I have light sensitivity problems. I also have bone cancer as well as osteoporosis, and adrenal deficiency syndrome, which means my adrenal gland system will shut down due to treatment.) In 1996, the legislature passed SB 253, a bill requiring insurers to cover the cost of annual prostate cancer screening for men 50 years or older. House Bill 416 would amend that law by requiring this screening be covered at age 40, and at age 35 for men at high risk of contracting this disease. "High risk" is defined in the bill as a person who is an African-American or who has a family history of prostate cancer. According to the American Cancer Society, this year 1.2 million Americans will contract cancer, which is every 25 seconds somebody will be diagnosed; and 552,000 will die of the disease, which is every 56 seconds. In our state, an estimated 1,500 Alaskans, or four a day, will contract cancer this year, 200 more people on an annual basis than three years ago. An estimated 700 Alaskans will die of cancer this year, 2 per day, or 58 per month. Prostate cancer accounts for 29 percent of all the male-related cancers and 11 percent of cancer-related deaths in men. This year, approximately 715 men in Alaska will be diagnosed with cancer, nearly one quarter with prostate cancer. Of the estimated 354 men that will die of cancer this year in Alaska, about 5 percent will die from prostate cancer. African- American men have a 32 percent higher risk of contracting this disease than others. In 1979, Dr. Gerald Murphy, a Seattle oncology/urologist, developed the Prostate Specific Blood Antigen [PSA] test to help diagnose prostate cancer ... The test became available to all doctors in 1990. A decade old, this test has led to a decrease in the prostate cancer mortality rate. In 1976, there was a 30 percent mortality rate for men with prostate cancer. In 2000, that mortality rate is expected to drop to 17.7 percent, due in large part to the PSA test. Today, more and more young men are being diagnosed with prostate cancer. According to the American Cancer Society, 209,900 men in the United States were diagnosed with prostate cancer in 1997, and 41,800 died of the disease. About 23 percent or 47,600 of those diagnosed that year were under age 65. As a patient who was diagnosed with prostate cancer at age 43, I know that prostate cancer in men under 65 tends to be more aggressive in nature. Early detection, especially for men who are high risk, is the best way to save lives. I have a vested interest in this legislation because my two sons have up to a six times higher risk of contracting prostate cancer because I have the disease. They now know with me, I was as young as 34. Located in your packet is a page listing statistical information ... which is the third page in, under the reference material, from the 1999 Alaska Cancer Registry reported data from 1996, and the 2000 American Cancer Society-Cancer Facts and Figures indicating the prostate cancer risk by age groupings. Statistics for 1999 and 2000 show that less than one in 10,000, a man is predicted to contract prostate cancer before age 40. In 1999, statistics for the 40 to 59 age group show one in 57 will contract the disease. In 1996, this was one in 59. The 2000 statistics show a greater occurrence in this age group, with one in 53. Four years ago the statistics in the 40 to 59 age group were one in 59. If this trend continues, in 2008, men in this age group will have a one in 35 chance of contracting prostate cancer. With an aging baby-boomer society, more and more men will be diagnosed with prostate cancer. It would be prudent for the State of Alaska and the insurance industry to make an investment in preventative health care maintenance for men starting prostate cancer screening at the age of 35 for those at high risk and age 40 for others. House Bill 416 will help men be diagnosed at a younger age, saving both lives and money. In 1999, Alaska Cancer Registry report shows that only two men, ... 40 to 44 were diagnosed with prostate cancer and ten in the 45 to 49 age group; I was one of those two men in 1996. At age 43 I was diagnosed with advanced prostate cancer. If the PSA test had been made available to me at age 40, I would probably have been diagnosed with early-state prostate cancer and my disease might not have spread. Over the weekend I spoke from a gentleman from North Pole ... he was diagnosed last April at the age of 48, and he was waiting for the age of 50 for the current screening to begin, with no known family history. I think that is a perfect example of why we might want to consider dropping this down to age 40 for that reason. Prostate cancer has left me unable to work. I, like many cancer survivors, [am] receiving Social Security Disability Income and State Disability Retirement. The average cost for prostate cancer treatment is $6,000 to $10,000 annually. My expenses are running $12,000 to $15,000 annually and that does not include the office visits; that's just medicine. It is cost-effective to catch and treat this disease early on, rather than pay for long-term cost of treatment estimated at $48,690 per person. If you refer to the first page of the reference material with the Pay Now or Pay Later diagram, ... it will show you that if a person from age 35 to 65 eats ten slices of low-fat cheese pizza per week, the tomato sauce contains cancer-fighting lycopene, which is a high anti-oxidant. ... The cost will be $18,720. But if you have or get prostate cancer, it will be $48,690 from diagnosis until death. Number 0660 House Bill 416 should not cause insurance premiums to increase. Although insurers generally oppose mandates, when SB 253 was passed in 1996, an Aetna representative testified that Aetna would not oppose this bill if the legislature felt the benefits of the screening would outweigh the small costs. He said an argument can be made that early detection should result in more efficient treatment and ultimately avoid high catastrophic treatment costs. Men dying of prostate cancer are leaving behind spouses, children and many family members and friends. While we have made great strides in the United States in cancer treatment research, too many men are still being lost at too young an age. An example I can give you: I was in attendance last year lobbying on Capitol Hill in Washington, D.C., with 100 other men and 18 spouses, and little Sebastian Hanson (ph) of Scottsdale, Arizona, stole everybody's heart. He was five months old when his father passed away of prostate cancer, and Sebastian Hanson (ph) will never, ever know what his father stood for. I lost a friend, ... Mark (indisc.) of Eugene, Oregon. He died at the age of 41 with advanced prostate cancer; and he left behind three children: a 10-year old daughter, a 14-year old son and a 16-year old son. Over the last four years approximately 700 Alaskan men have been diagnosed with prostate cancer. Many of their sons will also contract this disease. Let's give men an opportunity to be diagnosed at an earlier age. Those with a five-year survival rate from this disease have a 100 percent chance they will die of another cause. I would like to leave my two sons the best possible gift: an opportunity for them to be screened for prostate cancer at an earlier age, because the odds are that they will contract the disease at a younger age than I did. I urge your support of HB 416 for future health and well-being of all Alaskan families. Number 0795 MR. MILLER drew attention to the reference material, page 8, Cancer, Basic Facts. The material indicates if screenings are done for various cancers, the five-year relative survival rate for various cancers is about 80 percent. People who were diagnosed in 1995, there is an 80 percent success rate in 2000. If all Americans participate in a regular cancer screening, this rate would increase to 95 percent. Number 0874 REPRESENTATIVE GREEN asked Mr. Miller if there is a way to prevent prostate cancer. MR. MILLER said there is no way to prevent it. The lesions of prostate cancer start at puberty but are so minuscule they can't be measured. As a man ages, the level of prostate cancer will increase. In 1996, there were 9 to 11 million men walking around with prostate cancer. A doctor has said that figure is now 20 to 30 million. A low-fat diet is good; four years ago, [the effect of] diet was inconclusive, but diet is playing a factor. Diet and exercise are the least costly things that can be done to slow the onset of any disease. MR. MILLER thanked the committee for sponsoring this bill. He has spoken to 16,000 people in the last 43 months and over 14,410 Alaskans. In four different cases, he has run into men who are high risk; because they see an age limit, they are not going in to be tested. This bill will create more access and availability if men choose to be tested. Number 1035 REPRESENTATIVE BRICE asked if there have been any studies to cross-reference the preventative side and how those impact somebody who has the genetic predisposition to develop prostate cancer. Number 1062 MR. MILLER said there have been studies done on men to focus on diet, but how much that has slowed the onset of prostate cancer he doesn't believe has been that significant. It is just a matter of time that the majority of the men who have had family history are going to come down with it. He is encouraging his sons to watch their diets. He reported that canola oil, which is recommended as being good for the heart, has linoleic acid (as does red meat)in it, which is not advantageous for people that have family histories of prostate cancer because it promotes the onset of prostate cancer. CHAIRMAN DYSON asked Dr. Nakamura if this bill is good medical policy. Number 1183 DR. PETER NAKAMURA, Director, Central Office, Division of Public Health, Department of Health & Social Services, answered yes. He said he would support Mr. Miller in everything he said. Prostate cancer is a major problem and the sooner attention is paid to the problem, the better it will be. CHAIRMAN DYSON asked Mr. Evans if the insurance industry supports this. Number 1220 GORDON EVANS, Lobbyist, Health Insurance Association of America, answered yes. Number 1230 REPRESENTATIVE BRICE made a motion to move HB 416 out of committee with individual recommendations and indeterminate fiscal note. There being no objection, HB 416 moved from the House Health, Education and Social Services Committee. The committee took an at-ease from 3:25 p.m. to 3:26 p.m. HB 329 - INFO AND INFORMED CONSENT FOR ABORTION Number 1263 CHAIRMAN DYSON announced the next order of business as Sponsor Substitute for House Bill No. 329, "An Act relating to services and information available to pregnant women and other persons; and requiring informed consent and a 24-hour waiting period before an abortion may be performed unless there is a medical emergency." Number 1271 REPRESENTATIVE JOHN COGHILL, sponsor, presented SSHB 329. He explained that this is a work in progress, and he went over the sponsor statement, which read: I have introduced SSHB 329 for the purpose of protecting the health of women. Sponsor Substitute for HB 329 requires Alaska physicians to provide women seeking elective abortions information regarding the potential physical and psychological risks of the procedures, as well as alternatives to abortion. The U.S. Supreme Court noted in H.L. v. Matheson (1981) that "the medical, emotional, and psychological consequences of abortion are serious and can be lasting." Speaking to the issue of a woman's informed consent, the U.S. Supreme Court also observed in Planned Parenthood v. Danforth (1976) that a decision to have an abortion "is an important, and often a stressful one, and it is desirable and imperative that it be made with full knowledge of its nature and consequences." Recognizing the need for women to exercise an informed choice about an elective medical procedure, Alaska regulations since the early 1970s have required physicians to advise patients seeking abortion of the "medical implications and the possible emotional and physical sequelae of the procedures." (12 AAC 40.070). However, Alaska's informed consent provision lags behind other states because it exists only in regulation and not in statute. It also lacks specificity and is not uniform in its applications. More than twenty-five other states have laws requiring informed consent before abortions are performed, and detailing specific information that physicians must provide. States with the most comprehensive informed consent statutes include Indiana, Kansas, Kentucky, Michigan, Mississippi, Nebraska, North Dakota, Ohio, Pennsylvania, South Dakota, Utah, and Wisconsin. Sponsor Substitute for HB 329 elevates the informed consent requirement from regulation to statute, and it requires the Department of Health and Social Services to develop a standard information brochure that physicians will make available to women considering abortion. The brochure will include information on public and private agencies that provide services to assist pregnant women, including adoption services. The brochure will include objective information and photographs depicting the anatomical and physiological characteristics of a typical unborn child at two-week gestational increments. In addition, the brochure will describe the specific potential health risks of abortion, including infection, hemorrhage, breast cancer, danger to subsequent pregnancies, and infertility. REPRESENTATIVE COGHILL explained that there are five sections to this bill. Section 1 is a new section that requires the DHSS to develop a standard information brochure, which physicians would make available to women considering abortion, as well as a toll- free 24-hour-a-day telephone number. It also creates five new definitions for conception, fertilization, gestational age, pregnant and unborn child. Section 2 simply takes Section 1 and inserts it into existing statute under AS 18.16.010(a). Section 3 adds a new subsection and provides for civil liabilities to the pregnant woman by a person who induces an abortion without fulfilling the new informed consent provisions implemented in Section 4. Section 4 adds the informed consent requirements. It sets standards for when consent is voluntary and informed, and it defines medical emergency. Section 5 provides severability to the legislation so that if something is found unconstitutional, in anticipation of that, it doesn't throw the whole law out. Number 1575 REPRESENTATIVE COGHILL pointed out a drafting error on page 4, line 7. He suggested an amendment to strike "may" and add "shall." CHAIRMAN DYSON asked if there was any objection. Number 1609 REPRESENTATIVE BRICE objected because he wondered if it was a drafting style. He asked whether it was a mandatory or permissive "may." REPRESENTATIVE COGHILL said he wondered the same thing. Rather than question that, he proposed going ahead and putting what he thought emphatically should be in there. That way, if there ever is a question, the author's intent is there. "Shall" takes away the permissiveness of it. REPRESENTATIVE BRICE said there was no permissiveness in it to begin with. REPRESENTATIVE COGHILL said his intention was to have it emphatic. REPRESENTATIVE BRICE withdrew his objection. Number 1674 CHAIRMAN DYSON asked if there were any more objections. There being none, the amendment to strike "may" and add "shall" on page 4, line 7, was adopted. REPRESENTATIVE COGHILL reviewed Sections 1 through 5. He indicated that he was open to suggestions regarding the list in Section 4, informed consent requirements. He shared a sample of a brochure with the committee that is an example of what he suggested in the bill. Number 1786 REPRESENTATIVE BRICE referred to the part on page 4, line 31, which talks about informing the pregnant woman regarding the biological father's financial support requirement for child support. He asked how the Child Support Enforcement Division (CSED) is doing in terms of collecting child support. He said, "I think if we're going to be sitting there telling the mother that the father will be financially liable, then we also got to be pretty up-front and honest about how well they're doing." REPRESENTATIVE COGHILL agreed that CSED does have its problems. He said: We have been assured that they are increasing their ability to perform. At this point, my part is to make sure that she understands that responsibility. The responsibility is a matter of fact of law, and, therefore, I think it should be part of the discussion. That was my intent of putting it in there. REPRESENTATIVE BRICE said it is very specifically telling the mother the issue is there with child support, yet he understands that CSED is only "batting 500" in having all its cases up-to- date. Something like $500 million in arrearage is owed. He believes it is a bit disingenuous to say there is financial responsibility out there without saying, "By the way, you only have about a 50 percent chance of collecting an appropriate amount." REPRESENTATIVE COGHILL agreed to work on that. Number 1894 REPRESENTATIVE KEMPLEN referred to page 2, line 14, where photographs of a typical unborn child at two-week periods are being asked to be shown in the brochure. It is his understanding that one of the reasons abortions occur is because of deformed fetuses, and he wondered why those type of photographs are not included. REPRESENTATIVE COGHILL said he disagreed about what is viable and non-viable. However, he believes it would be best to show the normal range so that there is a starting place, which may then be departed from. He feels it would be unwise to show every possible problem. However, it would be wise to discuss the specific problem in light of what normal growth would be. It gives the woman the best available information about what is going on in the womb. Number 1966 REPRESENTATIVE KEMPLEN said it seems, based on that logic, that instead of the word "typical," it should say "her," so that the mother is able to visualize exactly what is anticipated to occur to her particular fetus. It is technologically possible with computer imaging and computer modeling. REPRESENTATIVE COGHILL said that information would be helpful but wouldn't be practical to put in a brochure at this point. REPRESENTATIVE BRICE asked what other medical procedures go into such depth in terms of mandating specific notification. He said no other medical procedure has this level of statutory requirement. Number 2028 REPRESENTATIVE COGHILL agreed with Representative Brice. Informed consent happens throughout the industry - it is not unusual to find in a medical procedure. He feels this one needs to be elevated because it is a society discussion on the value of that child inside a womb. Getting the best possible information to a woman at the time she is making a decision that will impact her and an offspring is very important. It needs to be elevated to make sure that the best possible information - medically, psychologically and socially - is available. He believes the brochure described in this bill is very appropriate to that. REPRESENTATIVE BRICE said he is glad Representative Coghill said that; he just questions the ability as a legislative body to make that determination better than a doctor's could. Number 2099 DR. PETER NAKAMURA, Director, Central Office, Division of Public Health, Department of Health & Social Services (DHSS), came forward to testify. He felt there was a need to comment on a number of issues. Definitions will determine very clearly what type of action by people will be taken related to this bill. He noted that the definition of conception in the bill is not correct. He explained that conception is a very specific process. First, when the ovum is penetrated by sperm, the pronuclei of both the male and female cell have to fuse and form a blastocyte. Most of the ovum that are penetrated by the sperm are rejected by the body and lost; very few actually end up in true conception. Conception starts when the blastocyte is implanted in the body and starts to develop. That is evident because the body begins to produce some hormones called human chorionic gonadotrophin (hGC). Pregnancy is started when the urine test indicates hGC is present. This definition is important because there are a lot of medications that are not recommended that a pregnant woman take, so the point of pregnancy is very critical. DR. NAKAMURA referred to the definition of the time of pregnancy. Pregnancy starts at the time of conception until the termination of the pregnancy. That is also critical because it impacts physicians in the way of treating a woman who may or may not be pregnant. He noted another critical definition is for unborn child. It states in this bill that from the time of conception until the time of delivery is an unborn child. This goes against medical definitions which require definite precision. He said that was a fetus, a developing fetus. An unborn child, if that term is used, is the point at which it can survive outside of the human body; not at the time it is a non-viable fetus--viable in the sense of being able to survive outside the body on its own. Number 2265 REPRESENTATIVE GREEN said: Isn't that issue still in a state of flux, whether or not it could survive outside the womb, that that is the time when it changes - in your opinion, but I'm thinking perhaps in a legal opinion - you could keep that baby alive, even though it couldn't survive on its own. Does that then change what you're saying is the time when it changes from a fetus to a human? DR. NAKAMURA replied that when it is said it can survive, he's speaking about a fetus that may not have sensory organs yet, may not even have a mouth that is open, and may not have the rest of the parts of the body fully developed; this is still a developing fetus. Once all the organs are developed to the point of survival of that fetus, then he would assume they could begin to talk about a child. REPRESENTATIVE GREEN said he hadn't made himself clear. He asked if it is possible to keep that child alive before it could survive outside the womb. Number 2327 DR. NAKAMURA said he didn't know of any possibility of keeping a fully undeveloped fetus alive. There may be additional information that he is not aware of, but he doesn't know how a non-viable fetus would be kept alive outside the body. REPRESENTATIVE COGHILL asked Dr. Nakamura to provide the definitions in written form. He said this bill is a work in progress, and he is willing to work on it. TAPE 00-32, SIDE B Number 2360 REPRESENTATIVE BRICE indicated he had quite a few questions for Dr. Nakamura and wanted to be sure he would be available after other testimony. CHAIRMAN DYSON asked Dr. Nakamura if "fetus" is Latin for unborn child. DR. NAKAMURA said he didn't know. As a physician, there is a definite way the term "fetus" is used. CHAIRMAN DYSON commented, "Those of us who do not want children to die only because they are unwanted are very, very resistant to any terminology that you want to use to dehumanize them." Number 2332 CHAIRMAN DYSON thought Representative Green's question was because premature babies have been kept alive that were born at 24 weeks. He added: I've heard evidence that some have survived at 19 weeks. I think Representative Green was after can we, with extraordinary means, keep unborn children, unborn fetuses alive at something less than full term, and will that technology improve in the future to the point where the child is not yet fully formed, we can make them survive. Number 2258 DR. NAKAMURA said when he said viable, viable means it can survive outside of the human body. If it is not viable, and it can be a premature infant, it can be a very early point of gestation, but viable means it can survive with support or intervention, but it can survive. There is a point at which it cannot survive. CHAIRMAN DYSON said the point at viability with assistance is probably a moving target as technology improves. DR. NAKAMURA encouraged the committee to have the willingness to listen if the terms are challenged. He stated that there needed to be medical use for the terminology. Number 2216 REPRESENTATIVE COGHILL shared the legal definition from Black's Law Dictionary: Conception. The beginning of pregnancy. As to human beings, the fecundation of the female ovum by the male spermatozoon resulting in human life capable of survival and maturation under normal conditions. He asked Dr. Nakamura for a medical definition to compare with this. DR. NAKAMURA agreed to get Representative Coghill a medical definition from the obstetricians who have made this determination. The reason for this determination is because it dictates treatment. Certain medications should not be given to a pregnant woman. REPRESENTATIVE COGHILL said he has to deal with the legal definition. But for treatment, doctors have to deal with the medical definition. He is trying to get the best possible information to a woman who is about to make some profound decisions in her life: Should she choose to get an abortion or not? REPRESENTATIVE COGHILL said the legal definition for fetus is: "An unborn child. The unborn offspring of any viviparious animal; specifically the unborn offspring in the post embryonic period after major structures have been outlined." Number 2134 DR. NAKAMURA noted that informed consent is good practice, and it is already required before any surgical procedure; whether it is written in regulation or law, it is required. He can't imagine a practitioner proceeding with any surgical intervention without informed consent. However, there is informed consent, and there is informed biased consent or biased counseling. When the information is provided that will be informed consent, it is very important that the full spectrum of information be provided. If presenting the information of the complexities of a pregnancy termination is going to be required, whether it be death or disability or whatever, it is very important that the information also be presented so the patient can understand what the complexities are of carrying the pregnancy to term. He added, "You can't just give half of the information and not give the other half of the information or that becomes biased information and prejudices the informed consent." DR. NAKAMURA continued that women who are pregnant can be offered the opportunity to read pamphlets and view pictures related to pregnancy but should not be required to do so. A requirement to do so can be especially cruel and traumatic to a woman who may actually desire to have that child and desire to carry that pregnancy but is unable to do that because of a medical or other complication. DR. NAKAMURA went on to say that no mention is made of historical alternatives to legal abortions are illegal abortions. An illegal abortion is not recommended as an alternative, but it is one. A woman may choose not to be pregnant and may decide to seek an illegal abortion rather than a safe, surgical intervention. CHAIRMAN DYSON asked Dr. Nakamura if he was recommending that women also be informed about illegal abortions and the dangers thereof. Number 2011 DR. NAKAMURA answered yes. But to provide that information will then allow a patient to really make a fully informed decision in terms of what she will do. Very often if a procedure is discouraged with limited information, women may seek an alternative way to terminate the condition which may be an illegal abortion. CHAIRMAN DYSON asked Dr. Nakamura if there are other illegal things he would want them to be informed about. DR. NAKAMURA said that is the one that came to mind because often a patient will seek that if she is discouraged or not allowed to seek a surgical intervention, which very definitely is the safest way, related to an illegal procedure. He suggested portraying the bad alternatives as well as those covered in this issue. Number 1931 REPRESENTATIVE COGHILL restated that this bill is to make sure that someone seeking an abortion gets the best information available. REPRESENTATIVE GREEN said they are not saying that the physician can't perform the abortion; he/she just needs to inform the woman before doing so. DR. NAKAMURA responded: Just as you should be informed of the alternative consequences of a surgical procedure, you should also be informed of the consequences of not having that procedure or having an alternative form of therapy or treatment. That is all I am saying. Number 1855 DR. NAKAMURA noted that fulfilling the requirements of SSHB 329 will require some fiscal and human resources; that was alluded to in the fiscal note. He concluded with a concern raised by medical professionals that legislating medical practice is a rather dangerous process. CHAIRMAN DYSON asked Dr. Nakamura if it was wise or unwise to include an amendment to inform the woman of what would be done with the remains of the unborn child or fetus or to let her know her options if she wished for some type of funeral service. Number 1733 DR. NAKAMURA said he wished there were a simple answer. Everyone responds so differently, and he can't really respond to the question. Number 1652 REBECCA HOWE testified via teleconference from Sitka. She spoke against HB 329 which she believes is a biased consent bill. This bill is not to help women in any shape or form who are making a very difficult decision. Instead it creates shame for women and infringes on their rights. Already women give consent, are told all the consequences of any surgical procedure and know what to expect. This bill is anti-choice legislation. She urged the committee to not let it go any further. Number 1601 SANDY DORAN testified via teleconference from the Matanuska- Susitna (Mat-Su) Legislative Information Office (LIO). She expressed support for HB 329. She had an abortion 17 years ago and had something like this been available, she would not have had one. It is important that women know this information; the doctors do not share anything like this. When someone is in crisis, she doesn't always think properly. She commented that abortion is a life-changing experience and will affect someone forever. A lot of women don't see that; they see it as a "hurry up and the problem is fixed." There are many emotional side effects. She urged the committee to support HB 329. Number 1534 EILEEN BECKER, Director, Homer Crisis Pregnancy Center, testified via teleconference from Homer. She indicated that HB 329 is long overdue. Women in crisis are unable to make a rational decision at the time. She deals with women in this situation, and they are desperate and feel like they have no other alternatives. With the 24-hour waiting period, it gives them a chance to seek other options. She has never met a women who wasn't sorry for the decision she made. Informed decision that requires the doctor's name is important. It is time to allow women to know all the facts and all the ramifications, good, bad and otherwise. The main thing she has heard from women who have had abortions is "I never knew, I never knew how this was going to affect me, I never knew how I would feel." Number 1412 ALEATHA MARTIN testified via teleconference from Fairbanks. She is a family nurse practitioner. She worked in the neonatal pediatric intensive care unit (NICU), adult intensive care and holds a Master of Science degree in Nursing and worked with Community Health Aid Program as an instructor. She had an abortion over 15 years for an unplanned pregnancy. She needed help but did not know where to get it. She had read in a psychology book that there were no lasting effects to abortion (15 years ago); however, that is untrue. Nobody told her how painful the actual procedure would be. She experienced complications following the procedure that resulted in a period of unconsciousness and a very long recovery period. Years later, when she and her husband wanted to start a family, she had difficulty carrying a baby to term due to cervical damage. She has lost four babies. She nearly lost her son through premature labor at 23 weeks, and they both nearly lost their lives due to an experimental drug used. MS. MARTIN said when she worked in a hospital, she observed physicians describing procedures that patients were to undergo so it was clear to the patient what the risks and side effects were. Giving the knowledge of the entire procedures should be common practice. She expressed support of HB 329. The fact is "it was my baby; I have emotional and psychological trauma that I deal with the rest of my life. And I have the medical experience and expertise from NICU to recognize that this baby has fingers and toes and a heartbeat very early on." Number 1227 REXANN BASSLER testified via teleconference from Anchorage. She is a counselor at a crisis pregnancy center. She recently counseled a 16-year old girl seeking an abortion who decided not to get an abortion when she was presented with all the facts. Ms. Bassler firmly believes that being presented with the facts helped this girl make an informed and humane decision. She believes the 24-hour waiting period is important because it allows women in crisis situations time to contemplate their decision after they have been presented with the medical brochure explaining the abortion procedure. MS. BASSLER shared another story about a young man who had paid for more than one abortion for his girlfriends. After he saw a sonogram, "it changed everything." He was clearly suffering from post-abortion syndrome. She submitted that abortion is not just about women and babies; there are emotional side effects to abortion and had the realities of fetal development been presented to this young man, perhaps he would have been more responsible in his lifestyle choices and in his decisions to pressure his girlfriends to get abortions. Number 1056 KAREN VOSBURGH, Executive Director, Alaska Right to Life, testified via teleconference from the Mat-Su LIO. She informed the committee that when a woman is considering abortion, very little factual information is given, and what is given is often false. Pre-born babies are sometimes referred to as "pregnancy tissue," "not alive yet," "just a bunch of cells," or only a "glob." These descriptions are given at a stage of development when the baby already feels pain, sucks its thumb and has a heartbeat. The United States does not have information in the zone of privacy by federal court ruling because it is unconstitutional. MS. VOSBURGH shared some abortion statistics from European nations with socialized medicine. There are over 100 complications associated with abortion. Some can be immediately spotted such as a puncture to the uterus or other organs, convulsions or even cardiac arrest. Other complications reveal themselves within two days such as a slow hemorrhage, pulmonary embolism, infection or fever. Records at a hospital in Great Britain revealed a 27 percent infection rate among women who had abortions, and 9.5 percent hemorrhaged enough to require a blood transfusion. Long-term complications usually result from damage to the reproductive system and can result in chronic infections or inability to carry a subsequent pregnancy to term or even sterility. According to one Japanese study, women undergoing abortions have experienced the following complications: nine were subsequently sterile; 14 percent suffered from reoccurring miscarriages; and there was a 400 percent increase in ectopic pregnancy. Recent studies indicate instances of total sterility following 4 to 5 percent of all abortions. She reported that the suicide rate among women who had abortions is phenomenally high. According to one study, women who had abortions are nine times more likely to attempt suicide. She also noted the breast cancer connection with abortion. Number 0803 HEIDI LIVENGOOD testified via teleconference from Fairbanks. She is a 19-year old student at the University of Alaska Fairbanks. She stated that HB 329 is a very important step in improving the medical care and education of women in Alaska about abortion. Abortion is a very popular and serious issue facing many people. The need to understand all the risks and complications of such a procedure is essential. Serious complications and risks after an abortion are pelvic and inflammatory disease, uterine perforations, possible increased risk of breast cancer and a 30 percent risk of ectopic pregnancy after the first abortion. After two or three abortions, the rate of ectopic pregnancy increases to 160 percent. If women are informed about these risks, then they may choose to give their child to another family. It is wise to give the mother as much information as possible before she chooses to terminate the life of her child before it is born. There is no reason why important information should be withheld from anyone that is considering abortion. Number 0699 ROZ JENKINS, Chairperson, Advisory Council, Planned Parenthood of Alaska, Sitka clinic, testified via teleconference from Sitka. She pointed out that this bill places an undue burden on the women of Alaska. Women in Southeast Alaska have to travel to Anchorage or other places to receive an abortion which adds more burden and financial cost. She referred to a particular study that shows after enactment of this law, the proportion of second trimester procedures increase by 53 percent. She has a copy of that study if anyone is interested. No woman lightly takes having an abortion without serious thought to the consequences and her options. CHAIRMAN DYSON asked Ms. Jenkins how would giving the woman the information increase the cost except for the 24-hour delay. MS. JENKINS answered that it is the 24-hour delay which increases the cost. Number 0584 DR. NELSON ISADA testified via teleconference from Anchorage. He is a perinatalogist, which is maternal fetal medicine. He is one of two perinatalogists in Alaska and sees many folks from all over the state. He expressed some concerns about HB 329. He has several concerns regarding the number of abortions and the psychological impact, but he is the one who has to see women at 2 a.m. or 4 a.m. when they come in from Fairbanks with ectopic pregnancy and placenta previa bleeding. Sometimes these occur in a previable time. What is or what isn't a medical emergency can be argued and often is in the eyes of the beholder. DR. ISADA said he is not terribly interested, when he is seeing the daughters, wives and girlfriends, in whipping out a flip chart at 2 o'clock in the morning. Showing a woman the pictures of how the fetus looks at every two weeks - when she is possibly bleeding to death - is not an option if he is trying to save her life. If there is an abnormal fetus detected on an ultrasound, he and his partner have to see these folks. He noted that the pictures are misleading. He does do informed consent and has for the past 22 years. He is the only quadruply board-certified physician on the planet; he is "boarded" in maternal fetal medicine, OB/GYN [obstetrics/gynecology], internal medicine and medical genetics. That is why he sees a lot of folks in this terribly tragic situation. He understands the intent of the bill, but he doesn't need this. REPRESENTATIVE BRICE said it has been alluded to that there is no type of counseling or discussion with patients about the impacts of abortion services and procedures. He asked Dr. Isada what procedures he goes through in discussing the implications. DR. ISADA said he spends hours going through informed consent. He tells women up-front they could die, they could lose their uterus, they could be depressed or suicidal afterwards; if they are ambivalent about it, don't even think about it. As a geneticist he is bound to do nondirective counseling. He can't tell a woman either way; it is her decision. His job is to let people know it is medically possible. Number 0210 REPRESENTATIVE BRICE asked about the psychological impact to women who are facing an instance where the child will not be born alive and are made to go through the whole procedure outlined in HB 329. DR. ISADA answered it is very cruel. He understands the women who have had horrible abortion experiences but he doesn't want to add to the woman in front of him who is carrying a baby with defects for example and making her sit through the flip charts. He will have to her, "It's required by HB 329." CHAIRMAN DYSON understands that HB 329 has only to do with elective abortions; nothing to do with abortions of medical necessity. DR. ISADA said he doesn't want to threaten anyone; he wants to help get women through this procedure alive. He would be happy to work with anyone on this bill. TAPE 00-33, SIDE A Number 0001 CHAIRMAN DYSON agreed he is interested in keeping everyone as healthy as possible and making the best decisions. He wished all the practitioners were as ethical and concerned as Dr. Isada appeared to be. REPRESENTATIVE KEMPLEN asked Dr. Isada if the requirements outlined in HB 329 constitute directive counseling. DR. ISADA said yes. He said there are other ways to provide the information. Things could be improved, but he doesn't know if this is the best way to do it. Number 0187 KARL ASHENBRENNER, Juneau Pro-Choice Coalition, Member, Alaska Pro-Choice, came forward to testify in opposition to HB 329. The Juneau Pro-Choice Coalition is an organization which has identified more than 5,000 pro-choice voters in House Districts 3 and 4. Juneau Pro-Choice is a member of the Alaska Pro-Choice Alliance. He read the following testimony: Our organization's first comment on HB 329 is that it shows a profound and unnecessary distrust in Alaska women and their doctors. We believe strongly that government should refrain from interfering in private medical decisions and let women make such decisions in the privacy of their doctors' offices. Bills that mandate 24-hour waiting periods and biased counseling are strongly advocated by anti-abortion extremists because their agenda is to stop all abortions by making them difficult and/or impossible to get. It is common knowledge in the pro-choice community that waiting periods like the one proposed in this bill force women to confront shouting protestors twice. At the door of abortion clinics protestors use the opportunity to collect license plate numbers and identify patients. In the intervening 24 hours, they harass patients at home and try to interfere with whatever plans or decisions they are trying to make. All sense of privacy is lost for the patient. A 24-hour waiting period is especially restrictive in a state like Alaska where women in virtually all but a few communities are forced to travel great distances, such as to Anchorage, Seattle or elsewhere, to obtain an abortion. Women who live in communities where there is no abortion provider such as Juneau, Fairbanks, and virtually all bush villages, must travel to Anchorage or Seattle. The 24-hour waiting period adds to the length of the expense and the expense of the trip with extra hotel, food and child care costs and no doubt, lots of extra stress. It is quite common that 24-hour waiting periods really turn out to be longer because not all clinics provide daily services. Such waits can force women to delay an abortion until the second trimester of a pregnancy, which doctors claim will increase the risk of medical complications and therefore the cost. Juneau Pro-Choice Coalition also strongly objects to the provisions of this bill which attempt to bias the counseling of women in order to talk them out of an abortion. First, Alaska regulations already require that doctors provide patients with information about the possible consequences of an abortion. The additional requirements for counseling that are included in this bill are unnecessary and in the case of rape and incest victims, absolutely outrageous. The requirements to provide information in photos of the physiological characteristics of the fetus reminds our group of the Right to Life exhibits at the state fair. They ignore the legal issue of fetal viability and instead to play with the emotions of women by confronting them with the pictures of fetuses, forcing rape and incest victims to endure this is particularly insensitive and outrageous. Also the information required concerning child support is biased. It would leave out information that more than $570 million are overdue child support. They're owed to Alaskan families. More than half of the 37,000 child support cases are in arrears according to statistics from our own Department of Revenue, and this would not be included. We encourage the committee to stop this bill; the 24- hour waiting period is a ploy to assist protestors and invading a woman's right to privacy, and counseling is biased. The legislature needs to be addressing the real problems of Alaska such as our lack of a fiscal plan and the plight of abused children. This bill tries to create answers for problems that do not exist. Number 0508 CHAIRMAN DYSON asked Mr. Ashenbrenner if he thought department should repeal the current regulations on informed consent. MR. ASHENBRENNER said he believes the existing regulations on informed consent are more than adequate. CHAIRMAN DYSON asked Mr. Ashenbrenner if his organization would have any objection to this bill if it just had the things that are in the regulations. MR. ASHENBRENNER answered no. Number 0592 DEBBIE JOSLIN came forward to testify and read the following testimony: My husband Steven and I live in Delta Junction with our three children: Matthew, Emily and Victoria. Steven is the resource forester in our area. I am a homeschooling mom. I teach third and fourth grade Sunday School at our church. On January 15, 1999, I was 22 weeks pregnant when we drove 100 miles to Fairbanks for an ultrasound on our child. After a lengthy examination of the baby, I was told we were expecting a male child with multiple anomalies. The baby we named Isaiah John had a brain cyst, a missing or unconnected stomach and a hypoplastic left heart. We were given the name of a perinatologist in Anchorage. A perinatologist, as I understand it, is a doctor who specializes in unborn babies who have serious health complications. I spoke to this specialist over the phone and made arrangements to go to Anchorage and have another ultrasound. During that phone conversation she urged me to have the pregnancy terminated without even examining me. The reasons she listed were that the baby would probably die anyway, the medical expenses would be too great and that my own life was probably in danger. Keep in mind, I hadn't been examined at this point. I made an appointment with this doctor because I had been told she was the only perinatologist in the state; now I find out there are two. My husband and I drove 350 miles to keep that appointment, leaving Delta at 40 below zero. When we arrived for our appointment, we first saw a genetic counselor who went over some family history with us and explained that they thought Isaiah probably had Trisomy 18, a chromosomal abnormality (an extra number 18 chromosome). ... She expressed surprise that we were not considering terminating the pregnancy and asked several times whether we wanted to consider terminating the pregnancy. Another ultrasound was performed by a technician, and then the perinatologist took over the exam and listed the following anomalies: brain cyst, missing or unconnected stomach, hypoplastic left heart, eyes not properly spaced, underdeveloped chin, something wrong with spinal development, something wrong with his penis, rocker-bottom feet, possibly an extra toe and fluid in the abdominal cavity and lungs. We were told the fluid indicated that Isaiah was already in congestive heart failure and that he would never make it to his due date in May. The perinatologist told us that Isaiah would never respond to us if he were to live; we were told that all Trisomy infants were severely mentally retarded. She described a somewhat vegetative state but said that more probably he would be stillborn any day. She said that if he were to be born alive, he would only live for a few minutes. Later they adjusted it to a few hours, and then later yet they said maybe a day at most, and then finally, much later the doctors were saying a few days. We agreed to an amniocentesis that day to determine whether Isaiah did actually have Trisomy 18. Our hope was that he would not, and we could begin then to make plans for heart surgery. She told us doctors will not operate on Trisomy infants since they ALL die in infancy anyway. You can imagine what heavy hearts we had as we drove back to Delta. The plans and dreams I had had for my son were shelved as we instead discussed his funeral. Within a few days, I got a call from the genetic counselor with the preliminary test results which showed Isaiah had Trisomy 13. I asked how that differed from Trisomy 18, and she said it was worse. She asked again about termination, and I told her again that we were not interested in that. Almost immediately I got a call from my doctor in Fairbanks, who asked me about termination. I told her again that I was not interested in that. She told me that since my life was in danger ... and I had chosen to continue with the pregnancy, she could no longer be my doctor as she was a general practitioner and not qualified to handle such a case. I began seeing the osteopath doctor in Delta and an OB/GYN in Fairbanks. I told them what I had been told about the baby and about my own health. The OB/GYN doctor told me he could not understand why I had been told my life was in danger. He treated me during the remainder of the pregnancy, and I never had any complications or problems--only the usual complaints pregnant women suffer from. A couple of weeks after the preliminary results, the genetic counselor called with the final results from Isaiah's amniocentesis. It was final--Isaiah had Trisomy 13. She asked me again about termination, and I told her no again. I then asked her out of curiosity what she would do if I did say yes. She got very excited and told me that "there is the most wonderful clinic in Kansas." I asked if she meant Dr. Tiller's clinic and she said, "Yes, do you know him?" "No," I told her, "but I know about him." She offered to have other women who had had abortions call me, but I declined. Sensing that I was not interested in pursuing this further, she told me in a very apologetic voice that there is a parent support group, but well...they are rather positive. She made it sound as though positive was a bad thing to be. She then went on to tell me that she had information on this group, including an 800 number as well as pamphlets and books in her office that gave detailed information about Trisomy 18, 13 and other disorders including pictures. I called S.O.F.T. (Support Organization for Trisomy 18, 13 and Related Disorders) right away and found that they were indeed positive, but realistic. I told the woman over the phone about Isaiah's diagnosis, and she told me that probably they were right, but there was a chance he could live. She talked to me about the parents and I remember asking her, "Parents, you mean they have live children?" "Yes, some did," she said. "How old?" I was told that they varied, but there were a few children who were teenagers and even a couple of adults. The lady took my name and address and told me she would send me a family packet right a way. I also requested the books they had available: Trisomy 13, a Guideline for Families and Care of the Infant and Child with Trisomy 18 or 13. These were the books the genetic counselor had described, the very ones she had in her office. While the information was heartbreaking, it also offered some hope and some help. Those were two things we hadn't had much of. Not only did some of these children live, they played and smiled and laughed and talked and learned things and showed affection and responded to love and affection. We located a wonderful pediatrician in Fairbanks who agreed that Isaiah's chances were not good, but she was willing to do what she could to help him. We made the decision to hire her and made plans to deliver our baby in Fairbanks. On May 19, 1999, only 11 days before his due date, Isaiah John Joslin was born at Fairbanks Memorial Hospital. He weighed 6 pounds, l ounce and was 18 1/4 inches long. Isaiah was a pretty baby with lots of bright red hair. Isaiah had difficulty breathing when first born, but as the doctors and nurses checked him over, they could find no sign of the problems seen earlier on three different ultrasounds. The brain cyst, the stomach problem and hypoplastic heart were all missing as were all of the other problems earlier noted. No rocker-bottom feet; his eyes were fine; there was no extra toe. However, Isaiah suffered from a ventricular septal defect (VSD) - a hole in his heart. Although very serious, it was a far cry from the problems he had had earlier. Isaiah required oxygen and a nasal gastric tube for feeding. Because of the hole in his heart, he was too weak to nurse and had to be fed with a tube. Isaiah looked so normal that even the nursing staff agreed we should retest him. Test results again showed Isaiah to have Trisomy 13. He stayed in the hospital for 12 days and then came home where we cared for him for 20 days before he left us to go to be with the Lord in heaven. Those were some of the hardest but the sweetest days of my life. I am telling you this story so you can understand why I stand before you today and ask that you pass HB 329. After talking to other doctors and doing a great deal of research on my own and reading about Trisomy infants and because of my own personal experience, I believe my life was never in any danger. Yet, this undue burden was placed on me at a time when I already had plenty to worry about. I believe this was done to try and convince me to have the abortion. I was told that ALL Trisomy infants die. I now know that somewhere between 90 and 95 percent of all Trisomy infants die before one year of age. That doesn't leave much room for hope, I realize, but it is quite different than saying they ALL die. I was not told about the parent support group (S.O.F.T.) for over two weeks, not until they had finally given up on talking me into an abortion. Well, you may say they were not sure your child had Trisomy until the final results were in. Perhaps, but they were sure enough that they continually brought up termination. I drove 350 miles to see the doctor and was never shown the written information about this disorder that they had right there. Though they were careful to tell me every negative thing they could about the baby, I was never told of any of the risks of having an abortion. There was never any mention made of the risk to my health, either physical or emotional from having the abortion. I believe the doctors who repeatedly brought up termination probably meant well. The problem comes in where they apparently believed that their professional status, or their medical degrees placed them in a position to know better than me what was best for me, my family and my baby. That simply is not true. Giving life to Isaiah was hard on our family; but it wasn't TOO hard. It was expensive; but it wasn't TOO expensive. It was hard on the other children; but it wasn't TOO hard on the other children. Giving life to Isaiah blessed our family, including the other children. Because of his heart condition, Isaiah was always lethargic and sleepy and tired acting, but he was never in pain. The equipment which monitored his oxygen saturation rate showed that whenever we held him or showed affection to him, Isaiah was aware of it. His saturation levels would soar when he was being loved on. My daughter Emily, who is five, loves to recount the story of how Isaiah's oxygen saturation level was in the 60s the night before he died. I laid him in Emily's arms, and immediately his saturation level rose to 100. There seems to be a feeling out there that a successful life is one that is free from pain or suffering or trials, and that isn't true. Isaiah's life was successful. We loved him, and he loved us. We have been comforted and encouraged ever since Isaiah's death by reading of other families with Trisomy children in the S.O.F.T. newsletter. The letters and testimonials are all expressions of the love each family has for their infant or child. Many of them include pictures of their precious children, most of them deceased, but some still living. Some of them tell stories of medical professionals pressing them to have abortions are very similar to our experience. Without exception, every family expressed love and gratitude for the time they had had with their children, no matter how short. Uniform written information should include basic facts regarding fetal development and the risks associated with continuing the pregnancy versus terminating the pregnancy. Crisis pregnancies come in many different forms. For some women it can be a simple as finding out about WIC [federal Special Supplemental Nutritional Program for Women, Infants and Children], others may not even be aware that the child's father is legally responsible for helping to provide support. Over 90 percent of all babies diagnosed prenatally with Downs Syndrome are aborted. Could it be that those women don't know about the parent support groups out there? There is a wealth of information out there, and it would be a great help to doctors to have a booklet they could hand out to their patients. Of course, I would like for every mother to make the same decision I did, but I realize that won't happen. But every mother deserves to have all of the information pertinent to her situation so that she can make an intelligent informed decision. I stand before you today and say that if you vote against HB 329, you are saying, in effect, that women are not competent enough to be trusted with the facts regarding the health of their own bodies and that of their unborn children. A "no" vote says that you have no compassion for families and believe that doctors are better suited to make decisions for women and their unborn babies. A "yes" note for HB 329 sends an entirely different message. A vote for informed consent says that you have respect for the intelligence of women and you believe that they have the right to be trusted with the information necessary to make decisions for themselves. I trust and hope that this body of legislators will prove themselves to be in favor of women's rights. MS. JOSLIN commented on some questions to previous testimony and shared photos of her baby. Number 1426 DANIELLE SERINO, Staff to Representative John Coghill, Alaska State Legislature, came forward and read the written testimony of Wendy S. Cloyd: When I began my family in 1993 with the birth of my daughter, Carli Ann, I was thrilled to begin the journey of parenthood. I don't think I'd ever contemplated the miracle of life until I'd been a part of such a miracle. I had my second daughter, Candra, in 1994, then my son Matthew in 1996. I was pregnant with my fourth child in 1998 when I first learned that my son had Fragile X syndrome, an inherited genetic disorder which causes a myriad of issues, including mental retardation and autistic-like behavior. From that moment forward, there was a change in attitude in almost every health professional I encountered. Each of them seemed to express with urgency the need for me to have an amniocentesis to determine if the child I was carrying was Fragile X positive also. My immediate response was to tell them that I would wait for the child to be born before I had any test; after all, the information would not be used to determining whether or not I would keep the child, only for the purpose of preparation, if needed. Whispered and hushed tones usually followed suggesting that if I changed my mind, to let them know. They seemed to imply, that when I came to my senses, to let them know! In the meantime, my other two children were tested, and the results of those tests determined them to be positive for the full mutation of Fragile X Syndrome also. Each child has a 50-50 chance of inheriting the defective gene from a carrier mother or father. Three of three, so far were positive. With these results, doctors again urged me to have my unborn child tested. Again, I wondered what urgency they saw, other than to give me the option of terminating the pregnancy. Often with tears, I let them know that to consider my current pregnancy "disposable" gave the unarguable implication that the three already living in this world had less value. I tell you, not one medical professional ever volunteered to give me the entire story of abortion. It was presented as the only logical choice if a child were found to be carrying the full mutation of Fragile X Syndrome. The idea that those in the medical profession might find it an "unnecessary nuisance" to treat abortion with the seriousness that it demands is lunacy. A doctor will tell you not to be out in the sun if you are taking certain antibiotics, to avoid driving after taking a sedative and on and on. Why would it be too much to ask for a doctor to tell a patient the ramifications of abortion on a woman's body? I would have to assume that, in their minds, to do so would put the responsibility of a woman's physical and emotional health in their hands, and that seems to be more than they want to be accountable for. I urge you to make informed consent a simple and mandatory event in the discussion of abortion by those in the medical profession. Number 1563 ANN HARRISON testified via teleconference from Fairbanks. She has 35-years experience as a registered nurse and women's health care practitioner. The health of women and children has been the focus of her vocation. She and her colleagues provide pregnant women with unbiased information and since 1994 have been providing informed consent. They speak professionally and without judgment and do not make decisions for others. The vast majority of women who decide on terminating their pregnancy do so with great thought, knowledge and soul searching. MS. HARRISON strongly opposes HB 329. It is biased and anti- abortion, one sided and can only add to the stress of an already difficult time. Her conscience and professionalism have dictated that she educate pregnant women on the legal options of pregnancy: carrying to term and parenting, giving the child up for adoption, or terminating the pregnancy. She commented that pregnancy can be a joyous occasion for women or a very distressful time for women and the consequences can be serious and lasting. From that standpoint, she believes that professional knowledge about and compassionate abortion counseling is critical. Number 1695 DAWN HOOKS testified via teleconference from Anchorage in favor of HB 329. She gave the following testimony: At the age of 18, I was preparing myself for the upcoming fall to enter college. Two weeks before I was to leave home for school, I found out that I was seven- weeks pregnant. I was ashamed and very disappointed. I had been on the pill and thought that I was protecting myself. I told my mother and later told my boyfriend of the news hoping that someone would counsel me on what to do. My mother told me it was my choice, and my boyfriend thought I had to get on with my college plans and pursue my career. I did not know what to do. I thought about my goals and placed them as my guiding decision. I called numerous clinics and finally spoke to a nurse; she told me to come in the next day. I was told that I was so early in my pregnancy that the doctor would just be removing tissue. Had I known what she called tissue was my child--a living, moving, breathing part of me--I would not have had an abortion. If I was told all the facts and then given time to discuss this, or review them for myself, I would not have had an abortion. If I had been told what the procedure truly was, and the truth of fetal development, I would not have aborted my child 14 years ago. I can visually remember everything that led to that dreadful decision in my life. As I daily come to terms with that decision, I find it hard to stand by and let someone make the same decision that I did without knowing the truth of what an abortion is and its consequences. I witness to the fact that daily. I think of my child and realize that I did not give myself or my child a chance because I did not know the facts. I received more information regarding getting my wisdom tooth pulled than I did choosing an abortion. Number 1781 RUBY FLETCHER testified via teleconference from the Mat-Su LIO. She had two abortions and wanted to share how they affected her life. After the abortions she became more intent on justifying her right to choose abortion; she hated the booth at the fair because it showed her what she had done. She would become depressed at certain times of the year, and she didn't know why. She chose shortly after the abortions never to trust men, which caused many problems in her relationships; she began to use drugs and alcohol to numb the pain. She has loads of guilt and shame when she thought of her aborted babies and thought they hated her. Eleven years and three children later, she had a miscarriage at the same state of development as her aborted baby and realized what her aborted baby looked like. No one had given her that information. During the aftermath of the miscarriage, she grieved for three babies. She wished somebody would have told her what her babies looked like; not that it was just a glob of tissue. She expressed her support for HB 329. It is important that women know what their babies are. Number 1891 DR. COLLEEN MURPHY testified via teleconference from Anchorage in opposition to HB 329. She read the following testimony: I am an obstetrician-gynecologist who currently practices in private practice in Anchorage, Alaska. I have been in the state since 1987 and have delivered over 2000 babies. I'd like to speak against SSHB 329. I believe it is a very dangerous precedent into the practice of medicine by our legislators. There are very dangerous ambiguities contained in this bill and serious professional implications of allowing Alaskan lawmakers to define patient treatment options. As the American College of Obstetrics and Gynecologist's Executive Board stated in January 1999 [Statement of Policy]: "The intervention of legislative bodies into medical decision making is inappropriate, ill advised and dangerous." As well as the American Medical Association resolved in 1999 to oppose such practices of procedure-specific informed consent finding them "informed consent requirements for specific medical procedures often are not medically indicated and are never appropriate areas for codification in law." Regardless of what one thinks of about abortion, legislative intrusive in the licensed practice of medicine has very serious implications to the future of the profession of medicine in Alaska. These biased counseling laws, like waiting period requirements, residency requirements, physician only laws, and an array of other restrictions, are not created to protect women's health. The purpose is very clear. These laws are enacted to make a woman's very personal decision even more difficult. Biased counseling laws intimidate women and discourage them from seeking legal medical care and exercising their legal reproductive rights. Fear of criminal sanctions and the intrusive nature of these state prescribed litanies also serve to deter doctors from performing abortions, further exacerbating the present shortage. Opponents of choice only hope that if they create enough barriers like these that women will not be able to overcome them. I speak firmly in opposition to this bill. I feel it does a disservice to my patients and to your constituents statewide. CHAIRMAN DYSON referred to the Roe v. Wade decision and said as he remembered it, it said that the state had an increasing civil rights type interest in the second and third trimesters, and he asked Dr. Murphy if she and her profession disagreed with that. Number 2011 DR. MURPHY answered no, she believes the issue right now is the right to privacy. What is so interesting about HB 329 is how it is procedure specific. It does not seem that there is any sort of effort on the part of the legislature to be creating such codification for appendectomies, mastectomies, or any sort of procedure. Realistically, much of the previous testimony is based on informed consent done very many years ago. The standard of practice has radically changed in the last ten years. The medical/legal environment has radically changed. It is now the standard of care to provide a complete, concise, age-appropriate consent for virtually any sort of medical procedure, including abortion. Abortion should not be singled out for a detailed consent that is codified in the state law. CHAIRMAN DYSON asked if it was fair to infer in her view that there is nothing fundamentally different about an abortion than any other legal medical procedure. DR. MURPHY replied that an abortion is a medical procedure that is offered to a woman as part of the spectrum of prenatal care. There are some women who do not elect to continue a normal pregnancy; there are some women that become pregnant because of sexual assault; there are some women that have pregnancies that are abnormal that they elect not to continue. It is a spectrum of medical care that is legally provided in this country at this time. CHAIRMAN DYSON said "So in your view, there is no basis on which we ought to consider the rights of the unborn child." DR. MURPHY noted that the rights of the unborn child is a very complex issue. Currently she is involved in a case where they are trying to determine the beginning of life. "Frankly, if you look at the Alaska state statutes, it's defined as 'the presence of a heartbeat after birth as well as the presence of respiration.' So you need to look elsewhere where the definition of life has already been defined for criminal intent." Number 2143 RUTH EWIG testified via teleconference from Fairbanks. She thanked Representative Coghill for sponsoring informed consent before abortion. Abortion has been legal for 27 years yet there has been no accompanying law ensuring that pregnant women will be provided with the facts and risks of the abortion procedure to her and obviously her baby. She recommended the book Lime 5. It was the physician's discretion in each one of these case histories not to inform the women who are now either dead or permanently physically injured for life as the result of legal abortion. Lime 5 does not address emotional injury; that would require another larger book. She encouraged the committee to read this book. Number 2217 MARVELLE WILLIAMS testified via teleconference from Anchorage in favor of HB 329. Several years ago she found herself going through an unwanted pregnancy. She was under the misconception that because abortion was legal, it was safe. After all, the fetus was not considered a child until it was born anyway. She was told she would experience a little pain and discomfort. No one told her about the years of guilt, remorse nor the unexplained depression. Had she been fully informed, she would have made another choice. Number 2276 CATHY GIRARD testified via teleconference from Anchorage. She stated that informed consent as it stands is not broken; please don't try to fix it. She is bothered by the government's continual pursuit to restrict Alaskans' freedoms to make their own reproductive decisions. Informed consent is nothing more than biased redundant counseling. Alaska already has an informed consent law for all medical procedures. She doesn't believe it is the legislature's business to mandate a woman or couple to wait for a medical procedure that could prevent a baby from being carried to full term because abortion is already legal and equally as important, safe. If she were faced with an unintended pregnancy, her counseling would be with friends, family and her own chosen sources, not a state-assigned counselor. Since she is responsible to pay taxes, she feels she is responsible to make her own parenting decisions on her own terms. MS. GIRARD continued, furthermore, HB 329 has changed the federal definition of pregnancy to the degree that it would render IUD [intrauterine device] and emergency contraception illegal in the state of Alaska. Currently, both methods are legal, simple and inexpensive ways to keep a fertilized egg from implanting in the womb and therefore prevent a future abortion. Abortion is stressful; but what about bringing an unwanted child into the world? An unwanted child, whether aborted or birthed, presents emotional and physical consequences no more or no less than the other during those pregnancies and long after the pregnancy as been aborted or carried to term. "If you are going to require two week incremental photos of fetus growth, I hope you are also going to require photos and statistics of what it's like to give up a baby for adoption. Or how about when a raped woman or incested girl might feel like after she sees her assailants face in her child's face? Or what it takes to become a parent? It appears that the underlying motivation for HB 329 is to dissuade pregnant girls and women from having abortions. This does not treat the three options, abortion, adoption and parenting, with equal consideration." TAPE 00-33, SIDE B Number 2353 KATHERINE DAVEY testified via teleconference from Anchorage. She is a health educator in Anchorage. She spoke today as a woman, a daughter and an adopted person, a life-long Alaskan and a voter. She strongly opposes HB 329; it is inaccurate, insensitive, unrealistic, irresponsible, dangerous, and it places as undue burden on Alaskan families. She appreciated Dr. Nakamura's input on the inaccuracies of the definitions within the bill. She would never challenge another person's belief about when life begins and believes that is best left to philosophy and religion. MS. DAVEY went on to say that HB 329 is insensitive regarding counseling a woman that the father is liable financially; that is unrealistic, as has been discussed previously, when the degree of compliance is noted. Even with federally mandated networking programs, only 15 states have signed up for that with a 20 percent success rate in getting the child support money. She cannot imagine a woman who has been raped being counseled that she can rely on the support of that rapist to provide money for that child. To force a woman to view gestational developmental pictures is especially insensitive when that pregnancy is wanted. She concluded that this is a dangerous bill. She noted that Mississippi passed the 24-hour waiting period and the incidences of second trimester abortions went up 53 percent; that is in a state where women can go to adjacent states and receive medical procedures. Women are not just restricted with a 24-hour time period; it ends up being weeks and weeks. Second trimester abortions are much more risky. Number 2244 ROBIN SMITH testified via teleconference from Anchorage in opposition to HB 329. She stated that this bill questions women's intelligence and their moral decision-making capabilities. The same woman's intelligence she questions will, nine months later, have total parental control over another human being simply if she endures a pregnancy. Does giving birth make a woman more intelligent or equal to men in making moral decisions? There already is a 24-hour waiting period for any woman considering abortion. This is a typical scenario: First, am I pregnant? How many days late is my period, three, four, a week? Then the home pregnancy test - positive. Could it be wrong? Go to a medical clinic and get a real pregnancy test. The test is positive; what do I do? Have the baby, be a parent; choose adoption; how about abortion? ... I've seen the pictures on TV so I know what a fetus looks like. I decide on abortion; I call the doctor's office to schedule an appointment; I cannot have one until I am seven-weeks pregnant. It will cost $550, and I have one more week to wait. The reason that they have to wait until seven weeks is because the doctors can't determine whether or not the tissue is actually the fetus until seven weeks. I arrive at the clinic, ... a nurse or physician talks to me to make sure this is my decision and I'm not being coerced into having an abortion by a parent or a partner. Am I aware of my other options? Do I fully understand the procedure? I sign the standard consent form; the abortion is performed. This is no simple decision. It is now three full weeks from the first day the woman missed her period. Do you really feel an additional 24-hour waiting period is needed or just an added burden. ...Where will I get the money? The state is not paying for abortions for poor women despite a court order. I need to fly to Anchorage. Where will I stay? Who will take care of my children? Putting more obstacles in front of women just increases a woman's health risk; pregnancy is not benign; women do die in pregnancy. MS. SMITH shared a story which suggested a better way would be to require responsible sex education in school. It would have an impact on both men and women. This could potentially prevent unintended pregnancies and therefore abortions. She urged the committee to consider more appropriate action and vote no on this bill. Number 2115 JOYCE LAINE testified via teleconference from Anchorage in opposition to HB 329. She said she gave birth to a child 34 years ago after an unsuccessful illegal abortion attempt. She gave the child up for adoption feeling that was the only choice. She began living as another person, a person who had not had an out of wedlock child, and it has been only in the last few years that she has reemerged as a person who did that. She spent the better part of 34 years being ashamed because she had a child. She was date-raped and only figured that out a few years ago; all this time she thought it was her fault. That was a heavy burden that spoiled her family relations and lost friends. Twenty three years ago, she and her ex-husband adopted a five-year girl who was not given up by her mother at birth, nor was she aborted because the mother was married at the time. The mother was woefully inadequate as a parent. She beat the child, the child was sexually abused, neglected, shut in closets and made to suffer dreadful things because she was kept by somebody who had no business of being a parent. Going ahead and having a baby does not ensure that that child will live happily ever after with some loving family who adopts him/her. She stated that this bill is woefully inadequate, unnecessary, badly phrased and very biased. Number 1986 JENNIFER RUDINGER, Executive Director, Alaska Civil Liberties Union (ACLU), testified via teleconference from Anchorage. She referred to the earlier question of How does this bill increase the cost of abortion? In addition to what has already been mentioned about the 24-hour delay, specifically that will increase the complication of the surgery and increase the level of specialization required. In addition to increased costs in the delay due to rescheduling work, family and school obligations, there is also increased cost from the biased counseling provisions of the bill. MS. RUDINGER said HB 329 prohibits a trained counselor or nurse or another health care practitioner from providing the counseling to the patient, requiring instead that a doctor deliver the state's message. This stipulation has a direct effect on women's health and also drives up the cost. Many clinics experience serious difficulty in finding doctors willing and able to perform abortions, and the few who are available often find themselves barely able to meet the needs of their patients. By prohibiting doctors from delegating the counseling and related tasks to other trained professionals, this bill would make it far more difficult for clinics to provide women with the health care that they deserve. Furthermore, since the doctor's time costs much more than that of a nurse, clinician, social worker, or counselor, the doctor-only stipulation drives up the costs of abortion and other health services provided by clinics. MS. RUDINGER noted that the members of the ACLU oppose this bill because they believe it is unconstitutional under the Alaska constitution. She concluded with these points: Biased counseling gives women inaccurate and incomplete medical information; requiring that physicians deliver the biased lectures makes access to quality reproductive health care more difficult and expensive; informed consent is already required for medical procedures; biased counseling requirements violate standard medical practice and the doctor/patient relationship; waiting periods cause medical risks; waiting period laws demean women's decision-making ability. Number 1853 CHAIRMAN DYSON asked Ms. Rudinger if she would be willing to help the sponsor craft this bill so the information dissemination isn't biased. MS. RUDINGER replied the entire bill is biased in the language and the requirements; there is no way to make this bill unbiased. She basically said no. Number 1805 LAVERNE PETTIGER testified via teleconference from Anchorage. She expressed her support favor of HB 329 because it fills a need that is not there. Women can make an informed decision about abortion. She had an abortion 19 years ago, but there were many things that were not told to her then. The medical risks for the abortion procedure were not mentioned nor were infection, breast cancer, infertility, or psychological effects. There was no alternative to abortion. No pictures of the unborn child's gestational age were shown either. MS. PETTIGER said she believes if she had gotten all the information, she could have made a better decision at that time. When people are in crisis, they need more information to make an informed decision. Her abortion was paid for by the federal government, and she doesn't believe that should have happened. She doesn't remember doctor's name; he was vague about any information about the procedure. He never told her about any of the side effects. She regrets having an abortion. It comes down to giving people the facts so they can make informed decisions. She believes she would have her baby today if she had been given the facts. Number 1688 LEILA WISE, Alaska First Choice Alliance, a statewide coalition of organizations united in the commitment to protect reproductive rights, testified via teleconference from Anchorage. She made the following testimony: We oppose HB 329 and urge you to vote against this bill and to not pass it out of committee. The decision to choose an abortion is personal and private, and it's best left to a woman in those individual (indisc.) that she chooses to advise her--her family, her friends, her clergy, her physician. The provisions of this bill are invasive and punitive and are seemingly based on inaccurate information about medical practices and terminology. As I have sat here today, I've been struck by the testimony of other women who had abortions many years ago and who speak of not receiving the information that they would have liked to have obtained then. I'm happy to report that the standard of care has changed and that women today receive full and accurate information from their physicians and health care providers. I would also like to point out that the women who spoke today about choosing against abortion in the recent few years were provided information about the status of their pregnancies and made and exercised their freedom of choice to continue their pregnancies to term. I commend them for exercising their choices just as I applaud those women many years ago who exercised their choice at that time. This bill is inaccurate; it uses incorrect definitions. Abortion is a medical procedure and relying on Black's Law Dictionary is inappropriate; it is best to use only medically accepted and accurate terminology, and I appreciate the willingness of you to look at those definitions instead. In particular, we are concerned about the definition of conception, and that it could in fact ban the use of contraceptives, since contraceptive use is the best way to prevent pregnancy and abortions. This bill is intrusive; no other medical procedure requires a 24- hour waiting period for all women and no other waiting period of any kind punishes women exclusively. Abortion, like any other surgical procedure, requires informed consent. As with any surgical procedure, the physician and his/her staff convey that information. Are you going to require informed consent for (indisc.)? Will pregnant women and their families be shown pictures of the gestational age of children and then pictures of children as they develop through life, children who may have severe birth defects? Are you going to discuss the consequences of having a child and not receiving support from an absentee father? ... This bill is dangerous. Women in Alaska already face enormous burdens and challenges in locating abortion services. Many women must leave their homes even to obtain a first trimester procedure; it creates an enormous financial burden. Imposing a 24-hour waiting period will magnify that burden and as has already been pointed out would allow anti-choice extremists to harass women ... This bill dehumanizes women; it patronizes women; it shames them. We are very concerned about that. We believe that women are smart enough, responsible enough, capable enough, to make their own choices and to take responsibility for those choices. Number 1486 HUGH FLEISCHER testified via teleconference from Anchorage. He considers it to be inappropriate for the state of Alaska. He opposes the passage of HB 329 and believes it is unconstitutional. He respectfully asked the members of the House to not pass HB 329. Number 1438 CAREN ROBINSON, Lobbyist, Alaska Women's Lobby, came forward to testify. The Alaska Women's Lobby is a citizen activist group formed in 1982 dedicated to equality, and they strongly are against HB 329. Her experience included being director of the AWARE [Aiding Women in Abuse and Rape Emergencies] Shelter working with victims of rape and incest and being involved in working with women across the state. She urged the committee to reconsider the 24-hour waiting period. The main reason is women already go through a long process to decide to carry the pregnancy to term or to get an abortion. She doesn't know of anyone she has talked to who has found out she is pregnant and that day got an abortion. It usually has been a long, well- thought out process. Women in Alaska have to seek out the information of who and where they can go for an abortion. She recommended training people to advocate for themselves in medical situations to ask the questions. She urged the committee members to not pass the bill out of the committee and let the normal process continue to work as it does. [HB 329 was heard and held.] ADJOURNMENT There being no further business before the committee, the House Health, Education and Social Services Standing Committee meeting was adjourned at 5:59 p.m.