Legislature(2003 - 2004)

05/06/2003 03:11 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
                    ALASKA STATE LEGISLATURE                                                                                  
          HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES                                                                         
                       STANDING COMMITTEE                                                                                     
                          May 6, 2003                                                                                           
                           3:11 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Peggy Wilson, Chair                                                                                              
Representative Carl Gatto, Vice Chair                                                                                           
Representative John Coghill                                                                                                     
Representative Paul Seaton                                                                                                      
Representative Kelly Wolf                                                                                                       
Representative Sharon Cissna                                                                                                  
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Mary Kapsner                                                                                                     
                                                                                                                                
OTHER LEGISLATORS PRESENT                                                                                                     
                                                                                                                                
Representative Beth Kerttula                                                                                                    
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
CONFIRMATION HEARING                                                                                                            
                                                                                                                                
Professional Teaching Practices Commission                                                                                    
                                                                                                                                
     Cynthia Curran - Juneau, Alaska                                                                                            
                                                                                                                                
     - CONFIRMATION(S) ADVANCED                                                                                                 
                                                                                                                                
HOUSE BILL NO. 108                                                                                                              
"An  Act  relating to  establishing  a  screening, tracking,  and                                                               
intervention program  related to the hearing  ability of newborns                                                               
and  infants;   providing  an  exemption   to  licensure   as  an                                                               
audiologist  for  certain  persons performing  hearing  screening                                                               
tests;  relating to  insurance  coverage for  newborn and  infant                                                               
hearing screening; and providing for an effective date."                                                                        
                                                                                                                                
     - MOVED HB 108 OUT OF COMMITTEE                                                                                            
                                                                                                                                
HOUSE BILL NO. 292                                                                                                              
"An  Act  relating  to  information  and  services  available  to                                                               
pregnant women  and other persons; and  ensuring informed consent                                                               
before an abortion may be performed, except in cases of medical                                                                 
emergency."                                                                                                                     
                                                                                                                                
     - HEARD AND HELD                                                                                                           
                                                                                                                                
CONFIRMATION HEARING                                                                                                            
                                                                                                                                
University of Alaska, Board of Regents                                                                                        
                                                                                                                                
     - SCHEDULED BUT NOT HEARD                                                                                                  
                                                                                                                                
PREVIOUS ACTION                                                                                                               
                                                                                                                                
BILL: HB 108                                                                                                                  
SHORT TITLE:SCREENING NEWBORNS FOR HEARING ABILITY                                                                              
SPONSOR(S): REPRESENTATIVE(S)FOSTER                                                                                             
                                                                                                                                
Jrn-Date   Jrn-Page                     Action                                                                                  
02/19/03     0248       (H)        READ THE FIRST TIME -                                                                        
                                   REFERRALS                                                                                    
02/19/03     0248       (H)        HES, FIN                                                                                     
03/10/03     0497       (H)        COSPONSOR(S): GRUENBERG                                                                      
04/11/03     0946       (H)        COSPONSOR(S): WILSON                                                                         
05/01/03                (H)        HES AT 3:00 PM CAPITOL 106                                                                   
05/01/03                (H)        -- Meeting Canceled --                                                                       
05/06/03                (H)        HES AT 3:00 PM CAPITOL 106                                                                   
                                                                                                                                
BILL: HB 292                                                                                                                  
SHORT TITLE:ABORTION: INFORMED CONSENT; INFORMATION                                                                             
SPONSOR(S): REPRESENTATIVE(S)DAHLSTROM                                                                                          
                                                                                                                                
Jrn-Date   Jrn-Page                     Action                                                                                  
04/30/03     1202       (H)        READ THE FIRST TIME -                                                                        
                                   REFERRALS                                                                                    
04/30/03     1202       (H)        HES, JUD                                                                                     
05/06/03                (H)        HES AT 3:00 PM CAPITOL 106                                                                   
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
CYNTHIA CURRAN, Appointee                                                                                                       
to the Professional Teaching Practices Commission                                                                               
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified of her willingness to serve on                                                                   
the Professional Teaching Practices Commission and answered                                                                     
questions.                                                                                                                      
                                                                                                                                
PAUL LABOLLE, Staff                                                                                                             
to Representative Richard Foster                                                                                                
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 108 on behalf of                                                                              
Representative Foster, sponsor, and answered questions from the                                                                 
committee.                                                                                                                      
                                                                                                                                
SARA GAAR, M.D., Project Director                                                                                               
Alaska Dual Sensory Impairment Services and Special Education                                                                   
Services                                                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 108.                                                                            
                                                                                                                                
PHILLIP HOFSTEADER, M.D., Audiologist                                                                                           
North Sound Regional Hospital                                                                                                   
Nome, Alaska                                                                                                                    
POSITION STATEMENT:  Testified in support of HB 108 and answered                                                                
questions from the members.                                                                                                     
                                                                                                                                
STEPHANIE BIRCH, Children Health Unit Manager                                                                                   
Maternal Child and Family Health Section                                                                                        
Division of Public Health                                                                                                       
Department of Health and Social Services                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 108 and answered                                                                
questions from the members.                                                                                                     
                                                                                                                                
LISA OWENS, Director, Speech Therapist, and Audiologist                                                                         
Alaska Speech and Hearing Clinic                                                                                                
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 108.                                                                            
                                                                                                                                
MARTIN BEALS, M.D., Pediatrician                                                                                                
American Academy of Pediatricians                                                                                               
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 108 and answered                                                                
questions from the members.                                                                                                     
                                                                                                                                
LISA SIMON                                                                                                                      
Quota International                                                                                                             
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 108.                                                                            
                                                                                                                                
SUSAN WALKER                                                                                                                    
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 108.                                                                            
                                                                                                                                
MARY GRISCO, Executive Director                                                                                                 
All Alaska Pediatric Partnership                                                                                                
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 108.                                                                            
                                                                                                                                
MARIE LAVIGNE, Executive Director                                                                                               
Alaska Public Health Association                                                                                                
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 108.                                                                            
                                                                                                                                
REPRESENTATIVE NANCY DAHLSTROM                                                                                                  
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified as sponsor of HB 292.                                                                            
                                                                                                                                
SENATOR FRED DYSON                                                                                                              
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  As sponsor of  the companion bill [SB 30] to                                                               
HB 292,  testified in  support of HB  292 and  answered questions                                                               
from the members.                                                                                                               
                                                                                                                                
JASON HOULE, Staff                                                                                                              
to Senator Fred Dyson                                                                                                           
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:    Testified  in   support  of  HB  292  and                                                               
responded to questions from the members.                                                                                        
                                                                                                                                
COLLEEN MURPHY, M.D.                                                                                                            
Obstetrician/Gynecologist                                                                                                       
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:   Testified  in  opposition  to HB  292  and                                                               
answered questions from the members.                                                                                            
                                                                                                                                
DEBBIE JOSLIN                                                                                                                   
Delta Junction, Alaska                                                                                                          
POSITION STATEMENT:  Testified in support of HB 292.                                                                            
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
TAPE 03-39, SIDE A                                                                                                            
Number 0001                                                                                                                     
                                                                                                                                
CHAIR PEGGY WILSON called the  House Health, Education and Social                                                             
Services  Standing  Committee  meeting  to  order  at  3:11  p.m.                                                               
Representatives Wilson, Wolf, Seaton,  and Cissna were present at                                                               
the call  to order.   Representatives  Gatto and  Coghill arrived                                                               
while  the  meeting was  in  progress.   Representative  Kerttula                                                               
attended  the meeting  on behalf  of Representative  Kapsner, who                                                               
was excused.                                                                                                                    
                                                                                                                                
CONFIRMATION HEARING                                                                                                          
                                                                                                                                
Professional Teaching Practices Commission                                                                                    
                                                                                                                                
CHAIR  WILSON   announced  the  first  order   of  business,  the                                                               
confirmation hearing on the appointment  of Cynthia Curran to the                                                               
Professional Teaching Practices Commission.                                                                                     
                                                                                                                                
Number 0074                                                                                                                     
                                                                                                                                
CYNTHIA CURRAN, Appointee to  the Professional Teaching Practices                                                               
Commission, gave  a brief history  of her service to  Alaska, and                                                               
answered  questions from  the committee  members.   She told  the                                                               
committee that she has been  serving on the Professional Teaching                                                               
Practices Commission since  February of 2001.   The commission is                                                               
very important to  the people of Alaska  and especially important                                                               
for the students.  The  commission has done many things including                                                               
reviewing and providing input on  regulations from the Department                                                               
of Education  and Early  Development.   They have  discussed and,                                                               
unfortunately, had to suspended  or revoked certificates of those                                                               
people  who have  violated  the  code of  ethics.   Through  each                                                               
member's expertise she said she  has learned more about the field                                                               
of education and values what each member brings to it.                                                                          
                                                                                                                                
Number 0181                                                                                                                     
                                                                                                                                
REPRESENTATIVE WOLF  asked about  the commission's  activities in                                                               
terms  of suspending  teaching certificates  for  code of  ethics                                                               
violations.    He  ask  what  kind  of  activities  warrant  that                                                               
measure.                                                                                                                        
                                                                                                                                
MS. CURRAN  responded that  certain infractions  rise to  a level                                                               
that requires suspension of a  certificate.  One example might be                                                               
violation of  contract.  The  commission hears the case  and then                                                               
decides  on appropriate  action.   Teachers, administrators,  and                                                               
all  educators  fall  under  the   purview  of  the  Professional                                                               
Teachers Practices Commission.                                                                                                  
                                                                                                                                
REPRESENTATIVE WOLF  asked if there  is a big problem  with these                                                               
kinds of infractions as compared with other states.                                                                             
                                                                                                                                
Number 0266                                                                                                                     
                                                                                                                                
MS.  CURRAN responded  that she  isn't sure  because she  doesn't                                                               
have statistics  from other states.   She  said she can  speak to                                                               
the  situation in  California because,  as the  Administrator for                                                               
Education and  Teacher Certification, examples of  those kinds of                                                               
infractions cross her  desk every day.  There are  pages of cases                                                               
from California  where teaching certificates have  been suspended                                                               
or revoked.   Since Alaska  has fewer educators, there  are fewer                                                               
instances where this action must be taken.                                                                                      
                                                                                                                                
Number 0290                                                                                                                     
                                                                                                                                
CHAIR WILSON commented  that Ms. Curran has  an impressive resume                                                               
and it is obvious she is quite capable to sit on the commission.                                                                
                                                                                                                                
Number 0321                                                                                                                     
                                                                                                                                
REPRESENTATIVE  SEATON  moved  to  advance  the  confirmation  of                                                               
Cynthia Curran, Appointee to  the Professional Teaching Practices                                                               
Commission, to the joint session  for consideration.  There being                                                               
no objection, the confirmation of Cynthia Curran was advanced.                                                                  
                                                                                                                                
CHAIR  WILSON  announced  that  there  was  one  other  appointee                                                               
scheduled to  be heard today,  but that individual  was traveling                                                               
and unavailable.                                                                                                                
                                                                                                                                
HB 108-SCREENING NEWBORNS FOR HEARING ABILITY                                                                                 
                                                                                                                                
Number 0402                                                                                                                     
                                                                                                                                
CHAIR WILSON announced  that the next order of  business would be                                                               
HOUSE  BILL  NO.   108,  "An  Act  relating   to  establishing  a                                                               
screening,  tracking, and  intervention  program  related to  the                                                               
hearing ability  of newborns and infants;  providing an exemption                                                               
to  licensure as  an audiologist  for certain  persons performing                                                               
hearing  screening  tests;  relating to  insurance  coverage  for                                                               
newborn  and  infant  hearing screening;  and  providing  for  an                                                               
effective date."                                                                                                                
                                                                                                                                
Number 0480                                                                                                                     
                                                                                                                                
PAUL LABOLLE,  Staff to Representative Richard  Foster, presented                                                               
HB 108 on behalf of  Representative Foster, sponsor, and answered                                                               
questions  from the  committee.   He read  the following  sponsor                                                               
statement into the record:                                                                                                      
                                                                                                                                
     With the  discovery that a  baby's brain  develops more                                                                    
     rapidly   than   previously   believed,   concern   for                                                                    
     identification of  infant-hearing defects  has achieved                                                                    
     a new prominence.                                                                                                          
                                                                                                                                
     Over 30  states have  passed legislation  that provides                                                                    
     universal  newborn hearing  screening.   Several  other                                                                    
     states  screen  a   significant  portion  of  newborns.                                                                    
     Approximately  10,000 babies  are born  in Alaska  each                                                                    
     year.   Out  of that  number, thirty-to-forty  of these                                                                    
     newborns  are likely  to have  some type  of congenital                                                                    
     hearing loss.                                                                                                              
                                                                                                                                
     Even  though many  hospitals  and  clinics, within  the                                                                    
     state,  screen  high-risk   or  premature  infants  for                                                                    
     hearing loss,  about 50% of newborns  with hearing loss                                                                    
     are not identified.                                                                                                        
                                                                                                                                
     Most newborns with congenital hearing  loss who are not                                                                    
     identified  at birth  will not  be identified  until 18                                                                    
     months or  three years  of age.   By this  time certain                                                                    
     critical   periods    for   language    and   cognitive                                                                    
     development  have passed.   When  hearing  loss is  not                                                                    
     detected,  it  can result  in  lifelong  delays in  the                                                                    
     development of language, and other cognitive skills.                                                                       
                                                                                                                                
     Since hearing loss is more  common that any other birth                                                                    
     defect  and  since  it  has  a  significant  impact  on                                                                    
     cognitive  development, infant  screening  should be  a                                                                    
     priority within the state.                                                                                                 
                                                                                                                                
     This bill would insure  that newborns are screened, and                                                                    
     that a  reporting and  tracking system  is implemented.                                                                    
     The Department  of Health & Social  Services would have                                                                    
     the  responsibility  to  effectively  plan,  establish,                                                                    
     monitor, and  evaluate both the  screening availability                                                                    
     and tracking/reporting system.                                                                                             
                                                                                                                                
REPRESENTATIVE SEATON asked where the funding for the program                                                                   
will come from.                                                                                                                 
                                                                                                                                
Number 0610                                                                                                                     
                                                                                                                                
REPRESENTATIVE  WOLF  said  the  fiscal note  shows  the  funding                                                               
sources in FY  04 for $46,000 comes from general  funds.  He said                                                               
he does  not see any  federal receipts in  this fiscal note.   He                                                               
said he  believes that the  state already has programs  like this                                                               
set up since  his children have all been tested.   When his first                                                               
son was  born prematurely,  the hospital  tested him  for hearing                                                               
impairment.                                                                                                                     
                                                                                                                                
Number 0626                                                                                                                     
                                                                                                                                
CHAIR WILSON commented that in  Wrangell the hospital has quite a                                                               
lot  of  modern technology  available,  but  would not  have  the                                                               
equipment to  test for  hearing impairment for  infants.   In the                                                               
case of  Wrangell there are  only about 12  births per year.   It                                                               
seems  likely  that  the  hospital  would  have  to  contact  the                                                               
Ketchikan Hospital and request that  they send over the device to                                                               
do the testing.  She told the committee  it is not a test that is                                                               
done everywhere, especially in smaller communities.                                                                             
                                                                                                                                
MR. LABOLLE  responded that  90 percent of  the hospitals  in the                                                               
state  already do  infant screening;  however, small  communities                                                               
without hospitals are  not covered.  This bill  would provide for                                                               
those births.   This bill  sets up  a tracking program  for those                                                               
children that are screened so that  the state can follow them and                                                               
assure they receive the necessary treatment.                                                                                    
                                                                                                                                
CHAIR  WILSON commented  that the  first year's  funding is  only                                                               
$46,000.                                                                                                                        
                                                                                                                                
MR. LABOLLE replied that the reason  for the small fiscal note is                                                               
that there  is currently a  federal grant.   That grant  will run                                                               
out in 2005 and  that is why there is a large  jump in the fiscal                                                               
note.                                                                                                                           
                                                                                                                                
CHAIR  WILSON asked  Mr. Labolle  if he  knows how  many children                                                               
would not be screened if this bill does not pass.                                                                               
                                                                                                                                
MR. LABOLLE replied that Lisa  Owens, who is online, could better                                                               
respond to that questions.                                                                                                      
                                                                                                                                
Number 0808                                                                                                                     
                                                                                                                                
SARA   GAAR,  M.D.,   Project  Director,   Alaska  Dual   Sensory                                                               
Impairment Services and Special  Education Services, testified in                                                               
support of HB 108.  Dr. Gaar  told the committee the service is a                                                               
state  and   federally  funded   project  that   serves  children                                                               
throughout Alaska  from birth  to 22  years of  age who  are both                                                               
deaf  and  blind  or  dual-sensory impaired.    This  service  is                                                               
located  at the  Special Education  Service Agency  in Anchorage.                                                               
She told the committee she  strongly supports the newborn hearing                                                               
screening,  intervention,   and  tracking  program.     Permanent                                                               
hearing  loss occurs  three  times  in every  1,000  births.   In                                                               
Alaska that  is about 30  to 40 children  a year being  born with                                                               
permanent hearing loss.                                                                                                         
                                                                                                                                
DR. GAAR  said although  the numbers sound  low, hearing  loss is                                                               
the most common  congenital disorder in the United States.   If a                                                               
child's hearing  loss is not  detected at birth, it  is typically                                                               
two to three  years before the child is identified,  as delays in                                                               
speech and  language acquisition become  apparent.  She  said the                                                               
most significant impact of hearing  loss is the delay in language                                                               
acquisition  and academic  achievement.   These negative  impacts                                                               
occur  with children  with mild  to moderate  loss of  hearing as                                                               
well as those with severe and profound range of hearing loss.                                                                   
                                                                                                                                
DR. GAAR said  the average deaf child graduates  from high school                                                               
with a language and academic  achievement level of a fourth-grade                                                               
hearing  student.   The average  hard-of-hearing child  graduates                                                               
from high  school with reading  scores at the  fifth-grade level.                                                               
These are  really unacceptable academic achievement  levels, and,                                                               
sadly,  they have  not shown  any signs  of improvement  for more                                                               
than 30 years when the data was first collected.                                                                                
                                                                                                                                
Number 0936                                                                                                                     
                                                                                                                                
DR.  GAAR  pointed  out  that  these  delays  can  be  prevented.                                                               
Research  shows  that the  critical  variable  in preventing  low                                                               
achievement  is early  identification of  hearing loss  and early                                                               
intervention, which is  a critical factor.  That  is what newborn                                                               
screening can provide.   The most highly regarded  study and much                                                               
research supports the importance  of early identification between                                                               
zero and six months  of age.  After six months of  age there is a                                                               
significant  difference in  terms  of potential  for the  child's                                                               
language acquisition and academic performance later.                                                                            
                                                                                                                                
DR. GAAR said the cost of  newborn screening is only about $25 to                                                               
$35  per child.    The cost  of not  screening  or identifying  a                                                               
child's  hearing  loss  early   and  subsequently  providing  the                                                               
appropriate  intervention  leaves  the   child  with  a  lifelong                                                               
language  disadvantage.     Without  early   identification,  the                                                               
chances  of  that  child  ever  catching  up  linguistically  and                                                               
academically  are significantly  reduced.   This is  such a  high                                                               
price to  pay for  a situation  that can  be prevented.   Newborn                                                               
screening can  identify those babies  at less than six  months of                                                               
age.  Waiting until  two to three years of age is  too late.  Dr.                                                               
Gaar urged the committee to pass HB 108.                                                                                        
                                                                                                                                
Number 1025                                                                                                                     
                                                                                                                                
PHILLIP  HOFSTEADER,  M.D.,  Audiologist,  North  Sound  Regional                                                               
Hospital, testified in  support of HB 108  and answered questions                                                               
from the members.  Dr.  Hofsteader commented that Dr. Gaar really                                                               
said much  of what  he wanted  to share with  the committee.   He                                                               
told the committee  that what Dr. Gaar said is  entirely true and                                                               
that there  is statistical data to  back that up.   The 3-out-of-                                                               
1,000-births  figure is  actually a  little low.   There  is data                                                               
that says  it is  actually 4 or  5 out of  1,000 births  that are                                                               
hearing  impaired.   This is  significant.   Language development                                                               
begins  in  the  first  two   years  of  life.    Not  targeting,                                                               
diagnosing,  or intervening  with that  hearing loss  will create                                                               
delays.   The  cost-effectiveness  of the  program  is much  more                                                               
successful  if there  is early  intervention at  birth.   Doctors                                                               
Vickie  Thompson and  Albert Mehl  did a  study in  Colorado that                                                               
confirmed  this fact.   The  program itself  is not  only morally                                                               
significant, but cost-effective.                                                                                                
                                                                                                                                
Number 1109                                                                                                                     
                                                                                                                                
REPRESENTATIVE WOLF  commented that  the previous  testifier [Dr.                                                               
Gaar] said the  cost of screening is  $25 to $30 per  child.  The                                                               
fiscal note  shows about  780 children statewide  who need  to be                                                               
screened.   He said  he understands  the importance  of screening                                                               
because he has a son who  is a special-needs child who is hearing                                                               
impaired and his son does have a speech problem.                                                                                
                                                                                                                                
REPRESENTATIVE WOLF said  he doesn't believe $25 is  too much for                                                               
a family  to have pay  to have  their newborn child  screened for                                                               
hearing loss.   It is  the cost  of having a  pizza.  He  said he                                                               
would  invest that  in his  child  even if  he did  not have  the                                                               
money.   If it  was necessary  he said  he would  sell a  pint of                                                               
blood.   He  also pointed  out that  there are  so many  programs                                                               
nationwide that  address these problems.   For instance  March of                                                               
Dimes offers assistance.  He said  he is concerned about having a                                                               
fiscal note  on this  bill when  the state  of Alaska  has fiscal                                                               
problems.     He  asked   when  parents   are  going   to  assume                                                               
responsibilities for their children.                                                                                            
                                                                                                                                
Number 1228                                                                                                                     
                                                                                                                                
MR. LABOLLE responded that one  provision of the bill, Section 5,                                                               
page  3, lines  9-23, mandates  insurance coverage  that must  be                                                               
provided.   Under  mandatory insurance  minimums provided  within                                                               
the  bill, the  first screening  for newborn  infant for  hearing                                                               
loss  must be  covered by  the insurance  company and  subsequent                                                               
hearing tests  that are necessary  would also have to  be covered                                                               
by insurance.   He  told the committee  his understanding  of the                                                               
fiscal note is that the  primary cost involved deals with setting                                                               
up the tracking system and  administering the program itself, and                                                               
not so much the expense of testing.                                                                                             
                                                                                                                                
CHAIR  WILSON said  this committee  will be  looking at  the bill                                                               
with respect to the policy issue.   She wants members to focus on                                                               
whether the state should implement such  a program.  She said her                                                               
intent,  if the  members wish,  is to  the pass  the bill  out of                                                               
committee and send  it to the House Finance  Committee, where the                                                               
fiscal issues will be addressed.                                                                                                
                                                                                                                                
Number 1296                                                                                                                     
                                                                                                                                
REPRESENTATIVE  SEATON asked  if  the state  tracks children  for                                                               
anything else.                                                                                                                  
                                                                                                                                
MR. LABOLLE  responded that  he knows  there are  other mandatory                                                               
testing policies, but isn't sure if the state tracks them.                                                                      
                                                                                                                                
Number 1314                                                                                                                     
                                                                                                                                
REPRESENTATIVE SEATON  said he is  a little concerned  about this                                                               
tracking program and isn't sure  what that entails.  Unless there                                                               
is a communicable  disease, he said, he is fairly  sure the state                                                               
does not  track children.   Representative Seaton asked  if every                                                               
newborn child is screened and  tracked, whether or not he/she has                                                               
tested positively  for a hearing impairment  or not.  He  said if                                                               
that is the case, he is not comfortable with that.                                                                              
                                                                                                                                
Number 1380                                                                                                                     
                                                                                                                                
STEPHANIE  BIRCH, Children  Health Unit  Manager, Maternal  Child                                                               
and Family Health Section, Division  of Public Health, Department                                                               
of Health  and Social  Services, testified in  support of  HB 108                                                               
and answered  questions from the  members.   She said two  of the                                                               
programs  in  her  section  are  the  newborn  hearing  screening                                                               
program  and  the  metabolic  screening  program.    There  is  a                                                               
mandated metabolic  screening and  tracking program  for newborns                                                               
with  metabolic  disorders.     Children  are  screened  for  six                                                               
metabolic disorders,  and the division monitors  and tracks those                                                               
kids for  follow-up, as well as  for a diagnosis for  the rest of                                                               
their  lives.   It  is important  to make  sure  kids with  these                                                               
problems receive  medical treatment and  have medical homes.   It                                                               
is also important  to know the rates at which  these occur in the                                                               
population.   As a  result of having  that information  the state                                                               
and medical providers benefit.                                                                                                  
                                                                                                                                
MS. BIRCH,  in response  to the question  about the  fiscal note,                                                               
said  part  of those  funds  are  for  the tracking  program  and                                                               
intervention services.  The children  who are identified would be                                                               
put into an early intervention  program that provides specialized                                                               
resources for  hearing loss.   The number of  children identified                                                               
in the zero-to-three age grouping has  increased.  There may be a                                                               
need for  additional resources.   The cost  of these  services is                                                               
fixed in most  communities, but it tends to be  more expensive in                                                               
the  Bush communities.   Hospitals  have accepted  the costs  and                                                               
have  rolled  them into  maternity  packages,  which include  the                                                               
screening  portion for  newborns.   So  the $25  to  $30 cost  is                                                               
already taken  care of either through  insurance reimbursement or                                                               
through rolling the cost into the maternity charges.                                                                            
                                                                                                                                
Number 1522                                                                                                                     
                                                                                                                                
REPRESENTATIVE  SEATON commented  that  while  there is  tracking                                                               
taking place  already for children  with metabolic  problems, the                                                               
way he  reads this bill it  appears all children will  be tracked                                                               
whether they have hearing impairment or not.                                                                                    
                                                                                                                                
MS. BIRCH responded that the  newborn metabolic screening program                                                               
tracks all children;  however, there is a  more detailed tracking                                                               
of children  identified with metabolic  disorders.   This program                                                               
would have screening on record for  all children.  There may be a                                                               
large number  of children who  will fall into  high-risk category                                                               
and may not be identified at  birth.  A child can develop hearing                                                               
loss in  the first  three years  of life  because of  exposure to                                                               
illnesses while they  were in utero, or  because medications they                                                               
may have received  puts them at risk of  developing hearing loss.                                                               
The  tracking program  would track  those children  through their                                                               
third birthday.                                                                                                                 
                                                                                                                                
Number 1590                                                                                                                     
                                                                                                                                
MR.  LABOLLE   responded  to  Representative   Seaton's  question                                                               
concerning tracking of all children.   He told the committee that                                                               
only the  initial screening  is tracked  for those  found without                                                               
hearing loss.   If, however, the newborn does not  fall into that                                                               
category,  then  they will  not  be  subject to  confirmatory  or                                                               
follow-up testing.   Only the  initial hearing screening  will be                                                               
sent to the department.                                                                                                         
                                                                                                                                
REPRESENTATIVE SEATON  commented that  as he  reads the  bill, it                                                               
appears all newborns are tracked,  whether they are shown to have                                                               
hearing loss or not.  He asked  Mr. Labolle if he would point out                                                               
the  section in  the  bill  where it  clarifies  that only  those                                                               
newborns with hearing loss will be tracked.                                                                                     
                                                                                                                                
MR.  LABOLLE  responded  that  every  child  screened  will  have                                                               
his/her  screening reported  to  the  department; however,  those                                                               
passing  the screening  without any  signs of  hearing disability                                                               
will  not have  subsequent screening.   Only  those children  who                                                               
require subsequent screening are tracked by the department.                                                                     
                                                                                                                                
Number 1667                                                                                                                     
                                                                                                                                
CHAIR  WILSON referred  to page  5, lines  17-22, where  it talks                                                               
about  the tracking  and prevention  program.   It says  "initial                                                               
hearing  screening,   follow-up  components,  and  the   use  and                                                               
availability of the  system of services for  newborns and infants                                                               
who are deaf  and hard of hearing and their  families."  She said                                                               
her interpretation  of this language indicates  that the tracking                                                               
and intervention will  be on the infants who are  deaf or hard of                                                               
hearing and their families.                                                                                                     
                                                                                                                                
MS. BIRCH,  in response to Representative  Seaton, clarified that                                                               
all newborns  would be  screened, and  those screenings  would be                                                               
reported  to the  department.   The only  children that  would be                                                               
followed up  through their third  birthday are children  who fall                                                               
into a high-risk  category or have questionable  signs of hearing                                                               
loss.   There is a list  of criteria that the  department uses to                                                               
determine  which children  need to  be followed.   Currently  the                                                               
department is tracking about 300 children per year.                                                                             
                                                                                                                                
Number 1773                                                                                                                     
                                                                                                                                
LISA OWENS,  Director, Speech Therapist, and  Audiologist, Alaska                                                               
Speech and Hearing  Clinic, testified in support of HB  108.  She                                                               
told  the committee  she supports  the  bill because  there is  a                                                               
significant difference  in language development  between children                                                               
who  are  identified early  and  receive  early intervention  and                                                               
those  that do  not.    She clarified  that  when  she refers  to                                                               
children who are  identified early, she is  referring to children                                                               
who are identified  before six months of age.   Much research has                                                               
been  done on  brain  development and  studies  are showing  that                                                               
critical brain connections  are made in the first  three years of                                                               
life.   This also includes  the hearing  sense.  If  children are                                                               
deprived of  hearing sound for  the first  few years of  life, it                                                               
doesn't allow  their brains to make  these important connections.                                                               
These  children may  have  lifelong  problems including  auditory                                                               
processing,  language  development,   academic  achievement,  and                                                               
social interaction with peers.   Ms. Owens asked the committee to                                                               
listen to families who are willing  to share their stories.  If a                                                               
child is not  identified as hearing impaired by two  years of age                                                               
there are  significant gaps that may  never be closed.   She said                                                               
it would be a  shame to have even one child  not be identified at                                                               
birth.   The  state has  quality services  available.   There are                                                               
three to  four newborns in  every 1,000 who are  hearing impaired                                                               
which makes it the most common  condition for newborns.  She said                                                               
she knows that  Alaska faces some tough financial  times, but the                                                               
cost of educating these kids  will be significant if not detected                                                               
early.                                                                                                                          
                                                                                                                                
Number 1951                                                                                                                     
                                                                                                                                
MARTIN   BEALS,   M.D.,   Pediatrician,   American   Academy   of                                                               
Pediatricians,  testified  in support  of  HB  108, and  answered                                                               
questions from  the members.   Dr. Beals told the  committee that                                                               
the  American   Academy  of  Pediatrics  has   recommended  early                                                               
screening  program  with  follow-up  as this  bill  suggests  for                                                               
several  years  now.   The  academy  prefers universal  screening                                                               
versus the high-risk screening which  was mentioned by one of the                                                               
representatives  [Representative  Wolf]  who  said  his  son  was                                                               
screened  because of  his  premature  birth.   He  said that  the                                                               
medical community has been doing  high risk screening on children                                                               
for  over  20 years.    However,  half  of the  hearing  impaired                                                               
children were being missed by  only screening high-risk children.                                                               
This program is  an attempt to screen all children  because it is                                                               
difficult to know  who is high risk until the  screening is done.                                                               
Once  the infants  are  screened,  it is  important  to get  them                                                               
properly diagnosed if they have  a hearing impairment so they can                                                               
go on  and get some  of the benefits  that Dr. Gaar  talked about                                                               
earlier.  If this bill is  passed, a mandate from the state would                                                               
allow  the medical  community to  equalize some  of the  services                                                               
throughout  the  state.    Most  pediatricians  are  behind  this                                                               
program and  it has  been done  for years  in Anchorage.   Almost                                                               
every  birthing  hospital  will  have the  capacity  to  do  this                                                               
program, but  without some statewide  coordination there  will be                                                               
big peaks  and valleys in what  kind of follow-up is  going to be                                                               
done.   Early  diagnosis leads  to the  intervention that  allows                                                               
these children to be more advanced  in their abilities to take on                                                               
speech language communication.   Dr. Beals told  the committee he                                                               
is  very concerned  about the  Health  Insurance Portability  and                                                               
Accountability  Act   (HIPAA)  regulations   and  confidentiality                                                               
concerns that  come up whenever  there is information  sharing in                                                               
situations where there  is no support by a  legislative body that                                                               
says  this is  an important  thing to  follow-up on.   A  mandate                                                               
would allow doctors to communicate  better with professionals and                                                               
hospitals to allow the information to  get to the people who need                                                               
it, basically, the families.                                                                                                    
                                                                                                                                
Number 2063                                                                                                                     
                                                                                                                                
CHAIR WILSON commented that this  screening would probably save a                                                               
lot of money, too.                                                                                                              
                                                                                                                                
DR. BEALS said he believes so,  but no insurance company will see                                                               
this as a  money-saving device, in itself.  However,  there is no                                                               
question  that individual  families will  see benefits,  not just                                                               
monetarily, but emotionally, socially and other ways, as well.                                                                  
                                                                                                                                
LISA  SIMON,  Quota  International of  Fairbanks,  testified  via                                                               
teleconference  in support  of HB  108.   She told  the committee                                                               
that Quota  International of Fairbanks is  a service organization                                                               
whose main  focus is teaching hearing  impaired and disadvantaged                                                               
women and  children.  Ms. Simon  said she supports this  bill and                                                               
would like to see it passed out of committee.                                                                                   
                                                                                                                                
Number 2101                                                                                                                     
                                                                                                                                
SUSAN  WALKER testified  in  support of  HB 108.    She told  the                                                               
committee that she is  a parent of a deaf child.   He just turned                                                               
four  years old  and  was born  in  Anchorage.   He  is a  happy,                                                               
healthy child and  was diagnosed with a profound  hearing loss at                                                               
six months  of age.  The  reason that her son's  hearing loss was                                                               
diagnosed  so early  is that  he  has a  twin sister  and it  was                                                               
apparent that  he had issues  with sound and was  developing very                                                               
differently than his sister.  She  told the committee he is doing                                                               
very well.   He speaks  and his language  is on or  above average                                                               
for the  hearing impaired due to  the fact that his  hearing loss                                                               
was  caught at  such an  early  age.   She said  that she  really                                                               
supports  HB 108  because as  a  parent she  knows an  individual                                                               
cannot tell if a  child is deaf.  If they  are healthy and happy,                                                               
and are  always on the move,  they look like they  are responding                                                               
normally  and it  is so  difficult to  say that  the child  has a                                                               
hearing loss.   For the most part it is  invisible; a parent will                                                               
not see it.   A pediatrician will not see  it, either, because it                                                               
is not  something detectable by  doing a ear  check.  It  is very                                                               
important that children are screened at birth.                                                                                  
                                                                                                                                
Number 2157                                                                                                                     
                                                                                                                                
MS. WALKER  told the  committee her son  is doing  well attending                                                               
school in  the Anchorage School  District.   He is an  oral child                                                               
and  if someone  sat down  with books  with him,  they would  not                                                               
realize he has a hearing loss.                                                                                                  
                                                                                                                                
Number 2185                                                                                                                     
                                                                                                                                
MARY   GRISCO,   Executive   Director,   All   Alaska   Pediatric                                                               
Partnership, testified  via teleconference in support  of HB 108.                                                               
She told  the committee  the partners  include the  Alaska Native                                                               
Medical Center,  the Alaska Native Regional  Hospital, Providence                                                               
Alaska  Medical Center,  Fairbanks  Memorial  Hospital, State  of                                                               
Alaska,  Valley  Hospital,  and Elmendorf  Medical  Group.    The                                                               
organization  has  been interested  in  supporting  this kind  of                                                               
legislation for several years.  As  the members may know, many of                                                               
the hospitals  doing the screening  have been  frustrated because                                                               
there  is  no  way  of   tracking  or  following  up  on  infants                                                               
identified with  hearing loss.   She pointed  out that  the costs                                                               
that are avoided  later are the educational costs  down the road.                                                               
Most school  districts in  the state  can provide  information on                                                               
what it  costs to provide services  to a child with  hearing loss                                                               
that has  not been identified  until they enter  school, compared                                                               
to a child  like Ms. Walker's who was identified  at an early age                                                               
and can  be in the  regular classroom with no  classroom support.                                                               
She urge the committee to pass this legislation.                                                                                
                                                                                                                                
Number 2244                                                                                                                     
                                                                                                                                
MARIE   LAVIGNE,  Executive   Director,   Alaska  Public   Health                                                               
Association, testified  via teleconference in support  of HB 108.                                                               
She  told   the  committee  the  association   is  interested  in                                                               
developing  sound  health  policies   to  benefit  all  Alaskans.                                                               
Recognizing  the   importance  of  universal  screening   of  all                                                               
newborns is  a critical public  health intervention.   The Alaska                                                               
Public Health Association encourages  the committee to support HB
108.   Ms.  Lavigne  highlighted public  health strategies  which                                                               
included the  cost savings of  early intervention, and  urged the                                                               
committee  not to  stop with  the screening  itself because  what                                                               
happens  after the  screening  is important.    Families need  to                                                               
receive  appropriate information  and services  following hearing                                                               
screening and  have their  children begin  receiving intervention                                                               
at five  to six months  of age.  It  is also critical  to develop                                                               
teams that  work with the  child to  measure the impact  of early                                                               
identification of hearing  loss, track the gains  made, and areas                                                               
that need development.                                                                                                          
                                                                                                                                
Number 2300                                                                                                                     
                                                                                                                                
MS. LAVIGNE quoted Dr. Marion  Downs, a world-renowned pioneer in                                                               
pediatric audiology, as saying the following:                                                                                   
                                                                                                                                
     If  a child  can  be identified  at  birth and  receive                                                                    
     immediate intervention, then we have  done our job.  On                                                                    
     the other  hand, if we  do not detect the  hearing loss                                                                    
     until  the child  reaches two  years of  age or  later,                                                                    
     that child  in most cases  has lost the  opportunity to                                                                    
     catch up  with others of  her own  age.  Why,  with all                                                                    
     the  tools we  have, would  we  not seize  the time  to                                                                    
     establish   a    model   for   screening    and   early                                                                    
     identification?                                                                                                            
                                                                                                                                
MS. LAVIGNE  said those are  the challenges before  the committee                                                               
today.   HB  108 takes  an  important step  in universal  hearing                                                               
screening which would  build on the success of the  60 percent of                                                               
Alaska's  hospitals   and  birthing  centers  that   are  already                                                               
screening newborns.   To  assure that  all newborns  are screened                                                               
and that  a tracking  system is setup  will assure  that Alaska's                                                               
children who are deaf or  hearing impaired will receive the early                                                               
intervention services they need to fulfill their potential.                                                                     
                                                                                                                                
Number 2333                                                                                                                     
                                                                                                                                
REPRESENTATIVE WOLF moved to report  HB 108 out of committee with                                                               
individual  recommendations and  the  accompanying fiscal  notes.                                                               
There  being no  objection, HB  108 was  reported from  the House                                                               
Health, Education and Social Services Standing Committee.                                                                       
                                                                                                                                
HB 292-ABORTION: INFORMED CONSENT; INFORMATION                                                                                
                                                                                                                                
[Contains discussion of SB 30, the companion bill]                                                                              
                                                                                                                                
Number 2348                                                                                                                     
                                                                                                                                
CHAIR WILSON announced that the  final order of business would be                                                               
HOUSE BILL NO. 292, "An  Act relating to information and services                                                               
available  to  pregnant women  and  other  persons; and  ensuring                                                               
informed consent before  an abortion may be  performed, except in                                                               
cases of medical emergency."                                                                                                    
                                                                                                                                
TAPE 03-39, SIDE B                                                                                                            
                                                                                                                              
REPRESENTATIVE   NANCY  DAHLSTROM,   Alaska  State   Legislature,                                                               
sponsor, said [HB  292] is the companion to SB  30, both of which                                                               
ensure  that  pregnant women  have  a  way  to make  an  informed                                                               
decision about their health care options.                                                                                       
                                                                                                                                
Number 2351                                                                                                                     
                                                                                                                                
REPRESENTATIVE DAHLSTROM told the  committee that since the 1970s                                                               
Alaskan  physicians who  perform  or induce  abortions have  been                                                               
required by law and regulation  to inform patients of the medical                                                               
implications   and   the    possible   emotional   and   physical                                                               
consequences of the  procedure.  HB 292  raises these regulations                                                               
into statute  and standardizes the  information presented  to the                                                               
patients by means  of a web site that would  be maintained by the                                                               
Department of  Health and  Social Services.   This web  site will                                                               
list  accurate,  objective  information that  explains  resources                                                               
available to  pregnant women that  may assist them in  making and                                                               
implementing  their own  reproductive decisions.   Representative                                                               
Dahlstrom said she  believes this bill will enable  women to make                                                               
healthy,  educated choices  regarding  their  own individual  and                                                               
private circumstances.                                                                                                          
                                                                                                                                
REPRESENTATIVE DAHLSTROM  read from the sectional  analysis she'd                                                               
provided for 292, which stated [original punctuation provided]:                                                                 
                                                                                                                                
     Section   1  language   describes  the   interests  and                                                                    
     intentions  of the  Legislature's intervention  in this                                                                    
     issue.  Interests  include regulating medical practice,                                                                    
     protecting the life and health  and choices of pregnant                                                                    
     women,  and clarifying  a  physician's requirements  to                                                                    
     obtain informed  consent, which will in  turn, conserve                                                                    
     legal and judicial resources.                                                                                              
                                                                                                                                
     Section 2  directs the Department of  Health and Social                                                                    
     Services  to develop  a website  designed  to assist  a                                                                    
     pregnant  woman with  her reproductive  choices.   This                                                                    
     pamphlet  will provide  resources for  women to  use in                                                                    
     order  to  make and  implement  these  decisions.   The                                                                    
     material   will   include   information   specific   to                                                                    
     geographic   region,  adoption   services,  counseling,                                                                    
     abortion,   clinics,   medical   assistance   benefits,                                                                    
     requirements  for doctors  who performs  abortions, the                                                                    
     father's  liability,  fetal  development,  and  medical                                                                    
     risks or rewards for each procedure option.                                                                                
                                                                                                                                
     Section  3  adds that  abortion  may  not be  performed                                                                    
     unless  informed consent  is obtained,  as outlined  in                                                                    
     Section 4.                                                                                                                 
                                                                                                                                
     Section  4  adds  civil  liability  for  a  person  who                                                                    
     performs  or induces  an abortion  without meeting  the                                                                    
     informed consent  provisions.  A doctor  who prints the                                                                    
     website's  information   and  distributes  it   to  the                                                                    
     pregnant woman is not liable under this section.                                                                           
                                                                                                                                
     Section  5  states  the   terms  of  qualification  for                                                                    
     consent to  an abortion  to be informed  and voluntary.                                                                    
     Medical   emergency,  as   defined  in   this  section,                                                                    
     bypasses  the  informed   consent  requirements.    The                                                                    
     pregnant   woman  or   her  parent/guardian/etc.   will                                                                    
     certify  the   requirements  in  writing.     Voluntary                                                                    
     informed   means:  at   least  24   hours  before   the                                                                    
     procedure,   in   an   individual   and   private   and                                                                    
     confidential  setting,   the  physician   will  provide                                                                    
     information  on  the women's  individual  circumstances                                                                    
     including the physician's  name, gestational estimation                                                                    
     of the pregnancy  or how far along the woman  is in her                                                                    
     pregnancy, and  the nature and  risks of  the procedure                                                                    
     and  its  alternatives,  and the  availability  of  the                                                                    
     website's information.                                                                                                     
                                                                                                                                
     Section 6  adds to the current  abortion reporting law.                                                                    
     In  preparing  the  report, the  state  registrar  must                                                                    
     require whether or not the  pregnant woman received the                                                                    
     website's information.                                                                                                     
                                                                                                                                
     Section  6 provides  severability of  this legislation,                                                                    
     meaning that it could end.                                                                                                 
REPRESENTATIVE  DAHLSTROM told  the  committee that  she has  had                                                               
many  personal  experiences  in   talking  with  women  who  have                                                               
undergone  abortions   for  various  reasons.     Some  of  these                                                               
conversations took place  as recently as a few months  ago.  Just                                                               
after  this bill  was  filed a  woman came  into  her office  and                                                               
stated that  she had an  abortion seven  years ago and  was still                                                               
dealing with the consequences both  mentally and physically.  She                                                               
told Representative Dahlstrom she had  not been informed of these                                                               
consequences prior to the procedure.                                                                                            
                                                                                                                                
REPRESENTATIVE DAHLSTROM said  she has had occasion  to talk with                                                               
women who have  been suffering from the  consequences of abortion                                                               
from 30  years ago.   These personal discussions with  women have                                                               
not been  solicited conversations.   She told the  committee that                                                               
these  are women  who have  come to  her and  talked about  their                                                               
particular  situation.     From   these  discussions   she  feels                                                               
confident that there are many  women who, had they been informed,                                                               
might have  chosen a different route.   They might not  have, but                                                               
at least they  would have been given that opportunity.   She told                                                               
the committee  that HB 292  is extremely important  and something                                                               
that  the  legislature  needs  to consider  for  the  mental  and                                                               
physical health of all women in the state of Alaska.                                                                            
                                                                                                                                
Number 2186                                                                                                                     
                                                                                                                                
REPRESENTATIVE WOLF  asked Representative Dahlstrom if  this bill                                                               
refers to adult women over the age of 18.                                                                                       
                                                                                                                                
REPRESENTATIVE  DAHLSTROM  replied that  most  often  it will  be                                                               
adult women, however, she asked  the committee to look at Section                                                               
5 [page  6, lines 6-8] where  it says, "before the  abortion, the                                                               
woman or  another person whose  consent is required  certifies in                                                               
writing."   That language is in  the bill to allow  for a medical                                                               
emergency  where   the  female   patient  involved   is  mentally                                                               
incapable of  making the  decision and that  would be  the reason                                                               
for a  guardian's involvement.  The  patient in this case  may be                                                               
any age.                                                                                                                        
                                                                                                                                
Number 2125                                                                                                                     
                                                                                                                                
SENATOR FRED DYSON,  Alaska State Legislature, sponsor  of SB 30,                                                               
companion bill  to HB  292, testified  in support  of HB  292 and                                                               
answered  questions.   Senator Dyson  said this  legislation only                                                               
puts into law  what is already in regulation.   It doesn't change                                                               
the  requirements for  medical practitioners  to  present a  full                                                               
scope of medical information to their clients.                                                                                  
                                                                                                                                
SENATOR DYSON  said doctors don't  have to use  this information;                                                               
it only  provides them with  the choice of using  the information                                                               
that the Department  of Health and Social  Services has provided.                                                               
It  relieves  the  doctor  of some  responsibility  in  that  the                                                               
department  will  keep  all  of the  information  updated.    The                                                               
availability of  the information  on the  web site  also relieves                                                               
the  doctor  or  clinic  from  having  to  make  the  information                                                               
available  in different  languages  because  the department  will                                                               
take care of  that, also.  If the doctor  uses the state provided                                                               
material,  it will  mean he/she  is  immune from  being sued  for                                                               
failure to  provide adequate material.   Thus it gives  doctors a                                                               
choice, makes it easier, and gives physicians some immunity.                                                                    
                                                                                                                                
Number 2067                                                                                                                     
                                                                                                                                
SENATOR  DYSON asked  the  members  to listen  for  two or  three                                                               
themes  as  the committee  takes  testimony.    He said  when  he                                                               
started working  on the  bill he  was not  very excited  about it                                                               
because  he did  not think  it  did very  much.   However, as  he                                                               
listened to the  testimony against the bill [on  the Senate side]                                                               
he became more  excited about it.  There is  a continual argument                                                               
from people who  oppose the bill to say "do  not do anything that                                                               
raises the  awareness that this  is a developing human  person. "                                                               
Senator Dyson said it was fascinating  to hear people say that he                                                               
was not  being scientific because he  did not use the  Latin word                                                               
"fetus" instead  of unborn  child.   Even though  it is  an exact                                                               
translation, that theme was heard over  and over again.  He urged                                                               
the committee to  watch for the testimony that  keeps saying this                                                               
is not an unborn person, just  a problem that ought to be treated                                                               
like any other medical problem.                                                                                                 
                                                                                                                                
SENATOR  DYSON  said the  other  theme  that  was heard  was  the                                                               
question of  singling out this  particular medical  procedure and                                                               
pointing  out that  abortion is  perfectly  legal.   He told  the                                                               
committee informed  consent is required on  most procedures where                                                               
the doctor has  a responsibility to inform the  patient about the                                                               
procedure.                                                                                                                      
                                                                                                                                
SENATOR DYSON told the committee  another continual theme is that                                                               
this is the  doctor's business and the legislature  does not have                                                               
any  business addressing  this issue  because there  is no  human                                                               
rights component.                                                                                                               
                                                                                                                                
Number 1984                                                                                                                     
                                                                                                                                
SENATOR  DYSON said  those who  have  reservations about  killing                                                               
developing  children because  they are  unwanted or  inconvenient                                                               
want people  to deal with the  fact that there is  a human rights                                                               
element here  and abortion  ought to be  treated differently.   A                                                               
baby  child or  unborn child  is not  a tumor  or a  disease, and                                                               
children ought not  to be treated with a disease  or tumor theory                                                               
of medical practice.  Senator Dyson  said it is his position and,                                                               
he assumes,  Representative Dahlstrom's, that there  is something                                                               
fundamentally  different about  this one  medical procedure  that                                                               
causes - no  matter what an individual is going  to do - everyone                                                               
to want  to go forward  cautiously and thoughtfully with  all the                                                               
information available.                                                                                                          
                                                                                                                                
Number 1938                                                                                                                     
                                                                                                                                
SENATOR  DYSON  said,  like Representative  Dahlstrom,  he  knows                                                               
adult women  who still celebrate  the birthday of the  child that                                                               
would have  been born.   When they walk through  the supermarkets                                                               
and see  young people about the  age that child would  have been,                                                               
they are still thinking about it.   He told the committee he does                                                               
not want to put  more guilt on anyone, but he  does want women to                                                               
be  able to  make informed  decisions, particularly  the profound                                                               
ones that they must live with.                                                                                                  
                                                                                                                                
SENATOR  DYSON   urged  members  to  watch   for  arguments  that                                                               
dehumanize the fact that an unborn  child is a homo sapien.  Some                                                               
will give  the argument that  these operations should  be treated                                                               
like any  other legal medical  procedure and no differently.   He                                                               
said, "you  will be told to  butt out" if these  people think you                                                               
are interested in  this because of a human rights  issue.  If the                                                               
members  look  at the  history  of  the preceding  century  where                                                               
ethics were  left up to  doctors, it has  not always been  a good                                                               
practice.  Certainly,  the experiments done by  doctors that went                                                               
on in Nazi  Germany, experiments on allied  and Chinese prisoners                                                               
under the  Japanese, and  what United States  doctors did  in the                                                               
South  with  sickle  cell  anemia experiments  is  right  out  of                                                               
Dante's Inferno.   He asked  the members to forgive  his passion,                                                             
but urged  the members to  listen for the arguments  of ignorance                                                               
that will likely be heard.                                                                                                      
                                                                                                                                
SENATOR DYSON said  the Department of Health  and Social Services                                                               
has been very helpful in  determining alternative ways to present                                                               
information.   He also wanted  the members  to know that  much of                                                               
the  information in  the Legislative  Findings  [Section 1]  came                                                               
from the Department of Law, which they feel is very defensible.                                                                 
                                                                                                                                
Number 1866                                                                                                                     
                                                                                                                                
REPRESENTATIVE  CISSNA asked  Senator Dyson  about his  statement                                                               
that doctors  don't have to use  the web site.   However, the way                                                               
she reads  the bill  it sounds  a lot like  the doctor  has heavy                                                               
liability to prove  that the patient has read the  web site.  She                                                               
commented that  she thought there  was language in the  bill that                                                               
required the  doctor to read  the information him or  herself and                                                               
be familiar with it.                                                                                                            
                                                                                                                                
SENATOR DYSON  responded that  Representative Cissna  is correct.                                                               
According to  the bill,  doctors must  read the  information, but                                                               
have a choice  of providing their own information  or [using] the                                                               
web site.                                                                                                                       
                                                                                                                                
Number 1828                                                                                                                     
                                                                                                                                
REPRESENTATIVE  CISSNA asked  if there  is a  requirement in  the                                                               
bill  that  doctors   must  prove  that  the   patient  read  and                                                               
understood the  web site.   She said  this is different  than the                                                               
doctor providing his/her own information.                                                                                       
                                                                                                                                
Number 1808                                                                                                                     
                                                                                                                                
JASON  HOULE,  Staff  to  Senator   Fred  Dyson,  responded  that                                                               
physicians  already ensure  that they  received informed  consent                                                               
from their  patients for abortions.   Doctors normally  keep that                                                               
form in the patients' files.                                                                                                    
                                                                                                                                
Number 1790                                                                                                                     
                                                                                                                                
REPRESENTATIVE CISSNA  replied that this bill  would make doctors                                                               
liable  if they  don't make  the  consent form  available to  the                                                               
court.   This bill does  raise the liability  of the doctor.   It                                                               
does not  do anything different  except make doctors  more liable                                                               
and  make  them more  accountable  on  that specific  issue,  not                                                               
necessarily the  health of  the patient,  but that  their patient                                                               
has read something.                                                                                                             
                                                                                                                                
Number 1768                                                                                                                     
                                                                                                                                
MR.  HOULE replied  that  the language  indicates  the doctor  is                                                               
liable  if  he/she   does  not  speak  to  the   patient  of  the                                                               
availability  of  the web  site's  information.   The  doctor  is                                                               
liable  to  make  sure  the  patient is  informed  of  the  other                                                               
provisions as  well.   Whether the doctor  does that  through the                                                               
web site's information or on his/her  own terms or protocol is up                                                               
to the doctor.  The liability, as  far as the web site goes, just                                                               
speaks to providing  individuals with the information  that it is                                                               
out there.                                                                                                                      
                                                                                                                                
Number 1741                                                                                                                     
                                                                                                                                
REPRESENTATIVE  SEATON asked  the members  to look  at [pages  4,                                                               
lines 27-31, and page  5, lines 1 and 2], where  it says that the                                                               
woman was given a written copy  of the material maintained on the                                                               
Internet under AS 18.05.032 before  the abortion was performed or                                                               
induced.   Representative  Seaton  offered his  reading that  the                                                               
bill doesn't  give the doctor the  ability to inform in  any way,                                                               
other than  giving a written copy  of the information that  is on                                                               
that Internet  web site, before  the abortion happens.   He asked                                                               
if he is reading this correctly.                                                                                                
                                                                                                                                
SENATOR DYSON responded that if  the doctor does what is required                                                               
in that section  of the bill, then  he/she is home free.   If the                                                               
web site information  is given to the patient and  the doctor has                                                               
a record  in the file,  the doctor is free  from being sued.   He                                                               
told the committee that his  understanding from the Department of                                                               
Law  is that  if  the  doctor gives  other  information, that  is                                                               
certainly  a  good  defense.   This  compliance  is  an  absolute                                                               
defense  if the  doctor has  a  record that  he/she provided  the                                                               
state's  web site.   Senator  Dyson said  that is  Representative                                                               
Dahlstrom and his intention.                                                                                                    
                                                                                                                                
Number 1649                                                                                                                     
                                                                                                                                
CHAIR WILSON commented  that the language is clear  where it says                                                               
"gave to  the woman a  written copy of the  material maintained."                                                               
All  the  doctor would  have  to  do  is  have the  patient  sign                                                               
something that  says she saw the  material and read it.   That is                                                               
pretty typical  when a  doctor performs any  kind of  an invasive                                                               
procedure.                                                                                                                      
                                                                                                                                
REPRESENTATIVE CISSNA  pointed out  that it  is different.   This                                                               
requirement  is not  informed consent  where the  doctor explains                                                               
things, but rather it specifies  that certain information must be                                                               
read.  That is what the bill says.                                                                                              
                                                                                                                                
CHAIR WILSON disagreed  and read from [page 4,  lines 26-28], "if                                                               
the person demonstrates  by a preponderance of  the evidence that                                                               
the person gave to the woman a written copy of the material."                                                                   
                                                                                                                                
REPRESENTATIVE CISSNA  responded that the material  is maintained                                                               
on  the Internet.   That  is  different from  saying the  patient                                                               
knows what  the dangers  of anesthesia are.   She  reiterated her                                                               
concern that the bill says a specific thing must be read.                                                                       
                                                                                                                                
Number 1623                                                                                                                     
                                                                                                                                
CHAIR  WILSON replied  that she  understands what  Representative                                                               
Cissna is saying, but that isn't what the bill says.                                                                            
                                                                                                                                
REPRESENTATIVE SEATON added that as  he reads the language in the                                                               
bill, he  believes Senator  Dyson is correct.   He  read portions                                                               
from [page 4, line 23].                                                                                                         
                                                                                                                                
Number 1570                                                                                                                     
                                                                                                                                
REPRESENTATIVE BETH  KERTTULA thanked the committee  for allowing                                                               
her to  sit in on  the meeting  in the absence  of Representative                                                               
Kapsner.   She  asked if  this language  is a  complete bar  from                                                               
civil liability.   Representative Kerttula said she  is not clear                                                               
on the language  with respect to "considered to  comply" [Page 4,                                                               
line 26].   For example,  what if the  physician said, "I  do not                                                               
want to give the you  [patient] this information, I disagree with                                                               
this information,  in fact, I  think it is  all a bunch  of lies,                                                               
but  I  have  to  give you  this  information."    Representative                                                               
Kerttula  asked  if  that  is  still  a  complete  bar  to  civil                                                               
liability.  She suggested that needs to be checked.                                                                             
                                                                                                                                
CHAIR WILSON  replied that  the question will  be followed  up in                                                               
the Judiciary Committee.                                                                                                        
                                                                                                                                
Number 1528                                                                                                                     
                                                                                                                                
MR.  HOULE responded  to Representative  Kerttula's question,  by                                                               
saying  that  doctors  are  always   welcome  to  use  their  own                                                               
protocols and their  own systems of communicating  the nature and                                                               
risks.     Physicians  are  already   required  to  do   this  by                                                               
regulation.                                                                                                                     
                                                                                                                                
REPRESENTATIVE KERTTULA  asked if the physician  came forward and                                                               
said,  "I   have  informed  them",   then  would  that   also  be                                                               
compliance.                                                                                                                     
                                                                                                                                
CHAIR WILSON replied if the  physician had something signed, that                                                               
would cover  him/her.  That  protects the  doctor in that  he has                                                               
done what  is required.  If  he does not get  the signature, then                                                               
that is his/her liability.                                                                                                      
                                                                                                                                
Number 1509                                                                                                                     
                                                                                                                                
REPRESENTATIVE  SEATON said  he  believes it  is  more than  that                                                               
because on  Page 4, line 29,  it says that in  civil action there                                                               
is  a  rebuttable presumption  that  the  abortion was  performed                                                               
without  the informed  consent  if the  physician  does not  have                                                               
written certification.                                                                                                          
                                                                                                                                
CHAIR WILSON agreed that it is  the doctor's liability.  She told                                                               
the  committee that  any hospital  or  clinic that  she knows  of                                                               
requires a signed  document saying the patient  has been informed                                                               
and knows  what the procedure will  be and the possible  pros and                                                               
cons associated  with it  before a surgeon  performs any  kind of                                                               
invasive procedure.  This is standard policy.                                                                                   
                                                                                                                                
Number 1437                                                                                                                     
                                                                                                                                
REPRESENTATIVE  CISSNA asked  about the  new HIPAA  requirements.                                                               
The departments are  concerned that it will make  it difficult to                                                               
get specific medical  information.  Some of this  language may be                                                               
effected  by  HIPAA.   Representative  Cissna  said that  she  is                                                               
concerned that the  committee has not looked  at the implications                                                               
of this  act effecting a  great deal  of legislation.   She asked                                                               
Representative Dahlstrom if she has checked on this.                                                                            
                                                                                                                                
Number 1385                                                                                                                     
                                                                                                                                
REPRESENTATIVE DAHLSTROM replied that  she cannot respond to that                                                               
question today, but will look into it.                                                                                          
                                                                                                                                
Number 1367                                                                                                                     
                                                                                                                                
COLLEEN   MURPHY,   M.D.,   Obstetrician/Gynecologist   (OB/GYN),                                                               
testified in  opposition to  HB 292  and answered  questions from                                                               
the members.   She told the committee she has  been practicing in                                                               
Anchorage since 1987, is board  certified by the American College                                                               
of Obstetricians and  Gynecologists, is a member  of the National                                                               
Abortion Federation,  and an  active abortion  provider.   HB 292                                                               
and SB 30  does not add to the care  of patients for terminations                                                               
in this state.   She said she believes this  bill just provides a                                                               
series of  pieces of  information that  the patients  are already                                                               
receiving  and,  in  particular,  produces  obstructions  in  the                                                               
provision of this  care.  Dr. Murphy said that  the committee may                                                               
not  already be  aware  that many  of the  patients  do not  have                                                               
access to these services and by  the time they actually get to an                                                               
abortion  provider there  has been  a delay  of several  weeks to                                                               
seek out that  care.  These patients have had  the opportunity to                                                               
research  and  think  about their  decision  without  necessarily                                                               
viewing   another  Internet-based   piece   of  information   and                                                               
graphics, and then  another 24-hour wait for a  decision that has                                                               
already been made.                                                                                                              
                                                                                                                                
Number 1271                                                                                                                     
                                                                                                                                
DR. MURPHY  told the  committee she'd seen  a patient  today whom                                                               
she'd told about  the legislative hearing this  afternoon.  She'd                                                               
explained to the patient that  it is the legislature's contention                                                               
that if  she knew more  about the resources available  to support                                                               
her to  carry the pregnancy to  term and adopt it  out, she would                                                               
change her  decision.  She'd asked  her if she would  like to see                                                               
pictures of  her embryo so she  can see the stage  of development                                                               
of the  fetus to  help her  make the decision.   Dr.  Murphy said                                                               
she'd asked her if she would  like to wait another 24 hours after                                                               
this discussion so to better make  the decision.  Dr. Murphy said                                                               
that  by  the  time  she'd  told her  all  the  things  that  the                                                               
committee  thinks would  be value-added,  her patient  was crying                                                               
uncontrollably.                                                                                                                 
                                                                                                                                
Number 1235                                                                                                                     
                                                                                                                                
DR. MURPHY  said any  woman who comes  for medical  terminuses is                                                               
already quite  vulnerable and to  put these added layers  to this                                                               
care  process is  basically  an  insult not  only  to the  female                                                               
patient,  but also  to the  provider.   She  went on  to say  the                                                               
legislature  is  questioning the  quality  of  care that  she  is                                                               
currently  providing  to  her  patients.   As  a  member  of  the                                                               
National Abortion  Federation she follows their  guidelines.  Dr.                                                               
Murphy pointed out  that she pays $60,000  in medical malpractice                                                               
each year  and the cost  is rising by 30  percent per year.   She                                                               
said she  is accountable to  so many  customers that to  go ahead                                                               
and  create more  statutes is  totally  unnecessary.   This is  a                                                               
blatant attempt to  try to reduce access  to termination services                                                               
in the state of Alaska  when these services are already seriously                                                               
compromised.  She believes this  legislation is totally unfair to                                                               
her  patients and  not  going to  produce  any different  outcome                                                               
except delays and  higher medical costs.  This bill  is an effort                                                               
to satisfying a small group of  people who have a personal agenda                                                               
about their  personal beliefs that  they should continue  to keep                                                               
personal and not make a state policy of it.                                                                                     
                                                                                                                                
Number 1174                                                                                                                     
                                                                                                                                
REPRESENTATIVE  COGHILL   commented  that  informed   consent  is                                                               
already in  regulation.  He asked  Dr. Murphy in what  manner she                                                               
administers that now.                                                                                                           
                                                                                                                                
DR.  MURPHY  replied that  when  a  woman  calls her  office  she                                                               
usually has already  learned she is pregnant  through a pregnancy                                                               
test.   Or, oftentimes she  goes to  a local provider  and learns                                                               
about different  options.  At  that point the patient  will learn                                                               
which  providers have  termination services  and call  her office                                                               
and listen  to a termination  hotline where there  is information                                                               
on the  procedure, costs,  and the  current wait.   If  the woman                                                               
elects to proceed with the  termination, she calls back and makes                                                               
an  appointment.   She sees  me, sign  a three-page  consent form                                                               
relating to  the termination, the  risks, the benefits,  and then                                                               
she comes back to the office  where she does a full physical exam                                                               
and an  ultrasound.   At the  time of  the ultrasound  Dr. Murphy                                                               
dates  the pregnancy,  the patient  views the  screen and  she is                                                               
sent  home  with a  picture  of  the  pregnancy.   Doctor  Murphy                                                               
summarized that the patient gives  an informed consent, she signs                                                               
a piece of paper, she sees  the pregnancy, and she goes home very                                                               
well informed of her decision.                                                                                                  
                                                                                                                                
Number 1082                                                                                                                     
                                                                                                                                
REPRESENTATIVE  COGHILL asked  if  Dr. Murphy  would provide  the                                                               
committee with  a copy of  the three-page informed  consent form.                                                               
In response to  Dr. Murphy's positive response, a  fax number for                                                               
the committee was provided.                                                                                                     
                                                                                                                                
DR. MURPHY  commented that some  of the regulations  proposed are                                                               
centered on facilities in which terminations are offered.                                                                       
                                                                                                                                
REPRESENTATIVE SEATON asked if her facility is in a hospital.                                                                   
                                                                                                                                
DR. MURPHY responded that  it is not.  It is  in a private office                                                               
in Anchorage.                                                                                                                   
                                                                                                                                
REPRESENTATIVE  SEATON  asked  Dr.  Murphy  if  this  bill  would                                                               
terminate her ability to perform services.                                                                                      
                                                                                                                                
DR.  MURPHY said  she is  not sure.   According  to what  she has                                                               
heard  the bill  was written  to say  that the  facility where  a                                                               
termination is provided  would have to be regulated  by the state                                                               
as well as the federal government.                                                                                              
                                                                                                                                
Number 0984                                                                                                                     
                                                                                                                                
REPRESENTATIVE  SEATON  pointed  to  Page  4,  line  9  where  it                                                               
requires that  abortion can  only be performed  in a  hospital or                                                               
other facility  approved for  that purpose  by the  Department of                                                               
Health and Social Services or  a hospital operated by the federal                                                               
government or an agency of the federal government.                                                                              
                                                                                                                                
DR. MURPHY commented  that she worked for  the federal government                                                               
from  1987 to  1999.   The federal  government's policy  does not                                                               
allow terminations of  pregnancies unless it is  incest, rape, or                                                               
the  mother's life  is in  jeopardy.   Currently, termination  of                                                               
pregnancies cannot  be performed at the  Alaska Regional Hospital                                                               
and generally  not at Providence  Alaska Medical  Center, either.                                                               
By putting that  language into the bill it  is eliminating access                                                               
to termination of pregnancy in Alaska.                                                                                          
                                                                                                                                
Number 0927                                                                                                                     
                                                                                                                                
MR. HOULE  pointed out  that the  section of  bill Dr.  Murphy is                                                               
referring to is already current law.                                                                                            
                                                                                                                                
DR. MURPHY responded then that  there are people breaking the law                                                               
because it is being offered safely  in an outpatient setting.  It                                                               
has  been  forced to  that  setting  because hospitals  will  not                                                               
provide it.                                                                                                                     
                                                                                                                                
Number 0892                                                                                                                     
                                                                                                                                
REPRESENTATIVE COGHILL  questioned if the licensing  procedure is                                                               
the method by which the  Department of Health and Social Services                                                               
is a part of the clinic.  He said he will look into it further.                                                                 
                                                                                                                                
REPRESENTATIVE CISSNA asked Dr.  Murphy if she believes reduction                                                               
of access  to abortions would  be unconstitutional because  it is                                                               
legal  in Alaska  and  throughout  the country.    She asked  Dr.                                                               
Murphy  to review  the  process of  examination  provided to  her                                                               
patients, the  three-page consent form,  and what she  sends home                                                               
with  the patients.    Representative Cissna  also  asked her  to                                                               
comment on the constitutionality question.                                                                                      
                                                                                                                                
DR.  MURPHY responded  that  she  is aware  of  the  Roe v.  Wade                                                             
decision in  1973 in which  termination of pregnancy  was allowed                                                               
in the  United States under  certain conditions.   Under Alaska's                                                               
constitution,  there  are even  greater  rights  to privacy,  and                                                               
Alaska  was  actually able  to  give  termination of  pregnancies                                                               
before  1973.   Some  decisions  have been  made  by the  Supreme                                                               
Court; there cannot be distinctions  between two sets of pregnant                                                               
patients who want  to continue their care in  pregnancy and those                                                               
who want to discontinue their  pregnancy and stop being pregnant.                                                               
That constitutionality has already been challenged.                                                                             
                                                                                                                                
DR. MURPHY  explained that  she does  a physical  examination and                                                               
dates the pregnancy  by the last menstrual period,  and then also                                                               
correlates  it  with an  ultrasound  in  which  the size  of  the                                                               
pregnancy  is  consistent  with the  last  menstrual  period  and                                                               
physical   examination.     Oftentimes,  the   outcome  is   very                                                               
different.   Then she takes  a pictures  to document the  size of                                                               
the pregnancy  and will  offer and usually  sends a  picture home                                                               
with the patient.  She said  95 percent of the patients will take                                                               
home a picture of the pregnancy.                                                                                                
                                                                                                                                
Number 0729                                                                                                                     
                                                                                                                                
REPRESENTATIVE SEATON asked if the  abortion is performed the day                                                               
of the exam.  He asked because  of her comment that she sends the                                                               
photograph home with the patient.                                                                                               
                                                                                                                                
Number 0711                                                                                                                     
                                                                                                                                
DR. MURPHY said usually the  patient will call for an appointment                                                               
and  often patients  have  to wait  several  days, and  sometimes                                                               
weeks due  to scheduling issues.   Depending upon  the pregnancy,                                                               
it  will  either  be  a   same-day  procedure  versus  a  two-day                                                               
procedure.  Two-day  procedures are basically for  women who have                                                               
a cervix  that is very firm  and may require softening  either by                                                               
laminaria, which are little heat  sponges that expand the cervix,                                                               
or tablets  that are  put inside  the vagina  to help  soften the                                                               
cervix,  but that  is generally  reserved for  people who  are in                                                               
advance gestation, after 12 weeks  of pregnancy.  The majority of                                                               
women can have surgical termination performed that same day.                                                                    
                                                                                                                                
Number 0644                                                                                                                     
                                                                                                                                
DR.  MURPHY  alerted the  committee  that  medical abortions  are                                                               
increasingly done up to nine weeks  of pregnancy.  A doctor gives                                                               
the patient  a pill called  RU 486  or mifepristone, which  is an                                                               
antiprogestin that  the patient  takes orally.   Two  days later,                                                               
she will  put four tablets high  in her vagina, which  will cause                                                               
her cervix to  further soften and the uterus to  contract.  After                                                               
that, she will  expel the dead tissue.  Depending  upon where the                                                               
patient  is located  in the  country,  this is  a growing  option                                                               
because of privacy concerns that  are being discussed today.  Dr.                                                               
Murphy said this  is a very safe option; 98  percent of the women                                                               
will pass  the tissue  at home without  needing a  dilatation and                                                               
curettage  (D and  C)  in  subsequent weeks.    It  will be  very                                                               
difficult   to   regulate   everyone's   home   for   the   self-                                                               
administration of voluntary termination of pregnancy.                                                                           
                                                                                                                                
Number 0594                                                                                                                     
                                                                                                                                
CHAIR WILSON  asked what  kind of follow-up  takes place  to make                                                               
sure there does not have to be a D and C performed.                                                                             
                                                                                                                                
DR. MURPHY replied  that every patient has a  reappointment for a                                                               
variety of  reasons.   She wants  to make  sure they  have healed                                                               
well,  to talk  about how  they are  making the  adjustment, and,                                                               
most  importantly, to  ensure that  they have  transitioned to  a                                                               
effective  form   of  contraception.    Every   patient,  whether                                                               
surgical or medical,  will get a follow-up visit.   Patients will                                                               
generally  come  back  between  one  to  three  weeks  after  the                                                               
surgical or medical  termination.  Another physical  exam is done                                                               
where  there  may  be another  ultrasound,  particularly  with  a                                                               
medical termination, to make sure the pregnancy sac has passed.                                                                 
                                                                                                                                
Number 0541                                                                                                                     
                                                                                                                                
CHAIR   WILSON  commented   that  she   knows  through   personal                                                               
experience working in a hospital  and clinic that people often do                                                               
not come back for follow-up  appointments.  She questioned how it                                                               
is  ensured  that  follow-up  appointments   are  kept  and  that                                                               
everything is okay.                                                                                                             
                                                                                                                                
Number 0511                                                                                                                     
                                                                                                                                
DR. MURPHY responded  that in the case of  a surgical termination                                                               
of pregnancy the  doctor will go ahead and  inspect the contents.                                                               
The doctor  will go  in with a  light and look  to make  sure the                                                               
appropriate  tissue  is  there.    Depending  upon  how  far  the                                                               
pregnancy is, there may be just  a little tiny bubble.  Generally                                                               
after  nine or  ten weeks  of pregnancy  there will  start to  be                                                               
signs of fetal  parts, and further on in pregnancy  there will be                                                               
parts of  the fetus.   The doctor  will reconstruct the  fetus to                                                               
make  sure it  was taken  out  intact.   Usually, after  surgical                                                               
termination of  pregnancy, the doctor  will confirm  the complete                                                               
evacuation  immediately after  procedure, and  the patient  knows                                                               
that it has been completely performed.   In the case of a medical                                                               
abortion, however, the doctor does  not get to inspect the tissue                                                               
at home, so generally the patient  comes back and a physical exam                                                               
is  done to  make sure  the uterus  has shrunk  and sometimes  an                                                               
ultrasounds is  done as backup  to make sure the  uterus expelled                                                               
the tissue.  The doctor always confirms it.                                                                                     
                                                                                                                                
Number 0387                                                                                                                     
                                                                                                                                
DR. MURPHY  addressed the compliance  issue by saying  that these                                                               
issues are  very much related  to access to  care.  When  so many                                                               
patients have  to travel again  for their follow-up, many  do not                                                               
come back to the original site.   So patients that travel usually                                                               
have their medical records sent  back to the community where they                                                               
live  and she  suggests  that they  get  follow-up care  locally.                                                               
These women always  go home with an  effective contraceptive plan                                                               
including  emergency  contraception  with backup  birth  control.                                                               
Some of these services can be  provided locally in terms of their                                                               
follow-up care.   A lot of doctors do not  offer medical abortion                                                               
because of the  lack of tissue confirmation to people  who do not                                                               
live on the road system.  She  said she has had some patients who                                                               
have elected  to stay in  town for the  48 hours period  and then                                                               
return the  following day to get  the ultrasound to make  sure it                                                               
passed  and then  go home  within three  or four  days after  the                                                               
procedure has been  started.  Compliance really has to  do with a                                                               
lot of different  factors.  In her practice that  is not an issue                                                               
because  most  patients are  very  motivated  to make  sure  this                                                               
process is completed and that  they transition to effective forms                                                               
of family planning.                                                                                                             
                                                                                                                                
Number 0339                                                                                                                     
                                                                                                                                
CHAIR WILSON  asked what her policy  is when there is  no follow-                                                               
up.                                                                                                                             
                                                                                                                                
DR.  MURPHY replied  that  her no-show  rate  is relatively  low.                                                               
Like any  appointment, her office  calls the patient to  find out                                                               
why they  did not  show up.   A letter  may also  be sent  to the                                                               
patient.   Depending on the  severity of the  patient's condition                                                               
it may  be necessary to chase  the her down until  she comes into                                                               
the  office.   In  the case  of a  medical  abortion the  Cytotec                                                               
tablets  which  help  to  evacuate the  uterus  are  very  rarely                                                               
associated with facial  deformities.  They occur in  about one in                                                               
one million, but  the medical abortion is  considered a teratogen                                                               
and it  is important  for the  pregnancy to pass.   She  said her                                                               
office  chases  those  women  down  to  make  sure  it  has  been                                                               
completed.   The only patient she  has not been able  to get back                                                               
in to see her is a police officer.                                                                                              
                                                                                                                                
Number 0227                                                                                                                     
                                                                                                                                
REPRESENTATIVE DAHLSTROM  thanked Dr.  Murphy for  calling today.                                                               
She said  that she has read  many articles about Dr.  Murphy over                                                               
the  years and  knows that  her  patients go  wherever she  goes.                                                               
Representative Dahlstrom said she  truly believes that Dr. Murphy                                                               
is  passionate about  providing what  she [Dr.  Murphy] considers                                                               
good health  care and wants her  to know that she  respects that.                                                               
She said  that she is glad  the Roe v. Wade  decision was brought                                                             
up because  she believes that  it is  important to state  for the                                                               
record that this legislation in no  way is debating what has been                                                               
set as the law  of the land.  Roe v. Wade is  done, and until the                                                             
day may  or may  not come  that someone  chooses to  debate that,                                                               
that is the law.                                                                                                                
                                                                                                                                
Number 0110                                                                                                                     
                                                                                                                                
REPRESENTATIVE DAHLSTROM  said she  is confident that  Dr. Murphy                                                               
does  give   information  to  her   patients,  but  it   is  very                                                               
interesting to  her that the  women she  has spoken with  and the                                                               
women she  has personal  relationships with have  told her  in no                                                               
uncertain terms that they were  not given information.  There are                                                               
many practicing  physicians who  are not  as thorough  as others.                                                               
There are  many that have  the opinion that  if it is  not talked                                                               
about,   the   procedure  will   make   the   problem  go   away.                                                               
Representative Dahlstrom reiterated  her personal experience with                                                               
women who have found that,  oftentimes, this technique worked for                                                               
a short  period of time, then  there are others who  have shelved                                                               
it for  20 or  30 years, and  then it  has come out.   In  all of                                                               
these cases,  they have had to  deal with it and  there have been                                                               
serious consequences.                                                                                                           
                                                                                                                                
Number 0072                                                                                                                     
                                                                                                                                
REPRESENTATIVE DAHLSTROM  said she doesn't believe  asking anyone                                                               
to consider  or reconsider  a health decision  is abusive  to the                                                               
patient.  She  said she understands and  respects that physicians                                                               
are  often  placed  in very  sensitive  situations.    Physicians                                                               
receive extensive training on how  to deal with these situations.                                                               
She  said  while  she  hasn't  met  Dr.  Murphy,  she  knows  her                                                               
reputation and  that her patients  follow her wherever  she goes,                                                               
so her rapport with them must be excellent.                                                                                     
                                                                                                                                
TAPE 03-40, SIDE A                                                                                                            
Number 0019                                                                                                                     
                                                                                                                                
REPRESENTATIVE DAHLSTROM said she  believes Dr. Murphy deals with                                                               
these  sensitive situations  very  carefully  and cautiously  and                                                               
that when  patients leave  her office they  don't feel  abused by                                                               
the  information  she  has  shared   with  them.    However,  she                                                               
expressed concern  that the child  is referred  to as a  state or                                                               
condition, not a living person.                                                                                                 
                                                                                                                                
Number 0133                                                                                                                     
                                                                                                                                
DR.  MURPHY explained  that doctors  are increasingly  aware that                                                               
they  must make  decisions  on evidence-based  medicine in  which                                                               
controlled prospective  and randomized  trials are  performed and                                                               
those  are  the  best  kind.     There  are  different  types  of                                                               
scientific  studies that  can  be  drawn that  are  not quite  as                                                               
reliable.    In  hearing  of  some  of  the  patients  that  have                                                               
approached  Representative  Dahlstrom  regarding  their  personal                                                               
decisions and  adjustments, she told  the committee  a researcher                                                               
would  say  it is  selection  bias  in  which  you are  seeing  a                                                               
subsection  of a  population that  is selected  out by  virtue of                                                               
their dissatisfaction  with their  decision and  their adjustment                                                               
to it.                                                                                                                          
                                                                                                                                
DR. MURPHY  suggested that Representative  Dahlstrom is  seeing a                                                               
skewed sampling  of that population.   This is  classic selection                                                               
biased for  what is heard.   Generally,  no one hears  from happy                                                               
people, only  from dissatisfied  people.  She  said as  a medical                                                               
doctor she is trained to use  medical terms and trained to call a                                                               
pregnancy an embryo up to eight  weeks in pregnancy, then a fetus                                                               
thereafter, and it is called a  neonate when it is born.  Doctors                                                               
don't  use other  terminology.   The  reason she  uses the  words                                                               
"pregnancy,  state,  or  condition"  is  because  termination  of                                                               
pregnancy can  be offered  across those  weeks of  gestation and,                                                               
therefore, she specifies embryo and fetus.                                                                                      
                                                                                                                                
Number 0242                                                                                                                     
                                                                                                                                
REPRESENTATIVE GATTO commented that Dr.  Murphy has used the term                                                               
"selection  bias" when  referring  to Representative  Dahlstrom's                                                               
experience.   He  said  he would  like  to look  at  that from  a                                                               
different  viewpoint.    Since  Dr.  Murphy  has  given  informed                                                               
consent  to patients  who  have  elected to  go  through with  an                                                               
abortion, he  asked about the  patients who return to  her office                                                               
with regrets.   Is there  some answer for these  individuals, for                                                               
instance, that she gave them everything  they needed to know?  Do                                                               
patients ever  come back  and say  she didn't  give them  all the                                                               
information?   It was treated  as an  object or a  termination of                                                               
pregnancy  and  a  lot  of  terms  that  make  the  issue  fairly                                                               
innocuous  by saying  "taking care  of the  patient's condition,"                                                               
rather than  "kill your baby."   He asked  Dr. Murphy if  she has                                                               
ever  used the  term "your  baby" and  suggested that  she has  a                                                               
selection bias by not using the term.                                                                                           
                                                                                                                                
Number 0320                                                                                                                     
                                                                                                                                
DR. MURPHY responded  that she just did  a postpartum examination                                                               
of a  patient and  she had  her baby  with her.   The  baby cried                                                               
while I  held it  and she  did her  depression questionnaire.   A                                                               
baby is a living  human being outside of the body.   She does not                                                               
refer to a fetus  or an embryo as a baby.   These are adult women                                                               
who have  the right to vote  and hopefully elect to  use it; they                                                               
can  drink alcohol;  they can  serve in  the United  States Armed                                                               
Forces; and they know what they want to do.                                                                                     
                                                                                                                                
Number 0391                                                                                                                     
                                                                                                                                
DR.  MURPHY  said  she  believes  that  Representative  Gatto  is                                                               
underestimating  the intelligence  of  women and  what they  know                                                               
about  their  bodies,  how  they  function,  and  how  they  grow                                                               
pregnancies.     She   said  that   she  appreciates   everyone's                                                               
viewpoints and  said that they  are good viewpoints that  work in                                                               
people's personal lives.  Dr.  Murphy told the committee she does                                                               
not believe it is appropriate to  make this a public policy based                                                               
on some  people's personal belief  systems which would  limit the                                                               
choice for  people to exercise their  choice as they see  fit for                                                               
their own lives.   Many women are  psychologically impacted, they                                                               
have  physical  conditions,  they  cannot  afford  it,  or  their                                                               
partner is  abusive.   Dr. Murphy said  with respect  to concerns                                                               
with people  coming back  with regrets, she  can only  recall one                                                               
patient   in  18   months  of   private  practice   in  providing                                                               
termination of  pregnancy.  That  young woman said  she regretted                                                               
terminating the  pregnancy.  She was  a victim of a  date rape in                                                               
which a young man  lured her to a local hotel and  she had a date                                                               
rape pregnancy  and elected to terminate  it.  She now  has a new                                                               
partner of  six months  duration, and  she has  not been  able to                                                               
conceive, and  she is  concerned that  it may  be related  to her                                                               
termination of pregnancy.   Her periods have  changed because she                                                               
has gained  50 pounds  and that interferes  with ovulation.   She                                                               
told the  committee she  has not  seen women  have the  degree of                                                               
regret that  has been  described in this  testimony.   Most women                                                               
feel relieved because they can access  this care and do what they                                                               
need to  do in their life  and continue their lives  in a healthy                                                               
manner.                                                                                                                         
                                                                                                                                
Number 0480                                                                                                                     
                                                                                                                                
REPRESENTATIVE GATTO told Dr. Murphy  that she is underestimating                                                               
his   intelligence   when  she   makes   a   statement  that   he                                                               
underestimates  the intelligence  of women.   Because  that is  a                                                               
statement she  has made  without any information  or data.   That                                                               
leads  me  to have  concerns  and  the  concerns  go right  to  a                                                               
selection bias.   He said  he believes  she has a  selection bias                                                               
when  using the  terms "termination  of pregnancy"  so often  and                                                               
rarely using  the term  "abortion".   He asked  if there  is some                                                               
selection bias  that she is  trying to influence  on individuals.                                                               
Representative Gatto pointed out that  she may not see people who                                                               
have regrets  because they do not  want to go back  to the person                                                               
who  caused them,  so they  take their  regrets to  someone else.                                                               
Probably,  to some  kind  of agency  that  deals with  depression                                                               
because  conceivably these  women will  be experience  depression                                                               
for the rest of  their lives, or certainly for a  while.  He said                                                               
that Dr. Murphy is not seeing  those people, so when she says she                                                               
only has had  one patient return to her with  regrets, he said he                                                               
believes she  is trying to  imply that  that is all  that exists.                                                               
He told Dr. Murphy  that she knows and he knows  that that is not                                                               
true.  He said he believes  she is using the exact same selection                                                               
bias when  formulating the information  that is presented  in the                                                               
form.                                                                                                                           
                                                                                                                                
Number 0582                                                                                                                     
                                                                                                                                
DR. MURPHY told the committee that  she subscribes to a number of                                                               
journals,  member of  the National  Abortion Federation,  and she                                                               
reads many  things related  to reproductive  health so  she draws                                                               
the information she provides partly  from personal experience, as                                                               
well as the data she  reads from these national and international                                                               
medical reviews.  She said she  also sees women when they are not                                                               
getting  pregnancies terminated.    She said  she  sees them  for                                                               
OB/GYN   care,   when  they   are   infertile,   when  they   are                                                               
postmenopausal, and she does routine pap smears.                                                                                
                                                                                                                                
DR. MURPHY said she asks  her patients about their OB/GYN history                                                               
and  gets a  lot of  stories about  how women  have gone  through                                                               
their   lives,   pregnancies,   miscarriages,   and   terminating                                                               
pregnancies, and  has discussed  each one of  those events.   Dr.                                                               
Murphy said that  she has over 1,500 women  seeking services with                                                               
her and  she knows  their detailed  reproductive history  and has                                                               
asked  them  questions   about  each  and  every   one  of  their                                                               
pregnancies.   She said her sample  size is much larger  than her                                                               
termination population.                                                                                                         
                                                                                                                                
DR.  MURPHY emphasized  that  43  percent of  women  will have  a                                                               
termination  of   pregnancy  by  age   40.    The   incidence  of                                                               
posttraumatic stress disorder for  termination of pregnancy by no                                                               
means approximates  43 percent of  the population.  She  said she                                                               
does take a detailed history  of her patients, learns about their                                                               
abortions many years after the fact.                                                                                            
                                                                                                                                
DR. MURPHY  told the  committee that  it is a  rarity to  hear of                                                               
posttraumatic stress disorders.   What she hears is  relief.  She                                                               
hears a  decision that  they made  many years  ago that  they can                                                               
live  with today  because  they are  here today.    She told  the                                                               
committee  she doesn't  judge patients,  but just  takes care  of                                                               
them.   She said all  people have  personal viewpoints on  how to                                                               
conduct  their lives.   They  get unconditional  health care  and                                                               
services.  This is so private, and it should stay private.                                                                      
                                                                                                                                
Number 0770                                                                                                                     
                                                                                                                                
REPRESENTATIVE SEATON asked  Dr. Murphy how her  practice will be                                                               
affected  by the  section of  the  bill that  requires a  24-hour                                                               
delay before an abortion can be performed.                                                                                      
                                                                                                                                
Number 0799                                                                                                                     
                                                                                                                                
DR. MURPHY responded  that if she has to make  an appointment for                                                               
the  following  day,  that  will be  one  more  appointment,  and                                                               
another patient cannot see her.   She said she has to charge that                                                               
patient for her time because she  pays $3,800 in rent and $60,000                                                               
in  malpractice insurance.   Dr.  Murphy  said she  will have  to                                                               
charge the  patient again for  what she  could have done  the day                                                               
before.   It  will  drive up  the  cost of  care,  it will  cause                                                               
unnecessary delay,  and she won't  be able to see  other patients                                                               
for contraception.                                                                                                              
                                                                                                                                
Number 0881                                                                                                                     
                                                                                                                                
DEBBIE JOSLIN testified via teleconference  in support of HB 292.                                                               
She told  the committee that this  bill is very important  to her                                                               
because in 1999  she and her husband were  expecting their fourth                                                               
child and found  out at approximately 22 weeks  of gestation that                                                               
their  little boy  had multiple  anomalies.   Ms. Joslin  and her                                                               
husband  named him  Isaiah.   He  had a  brain  cyst, possibly  a                                                               
missing or unconnected stomach, a  heart defect, and other health                                                               
problems.                                                                                                                       
                                                                                                                                
MS. JOSLIN said  these health problems were  discovered through a                                                               
routine ultrasound in  Fairbanks.  After this  discovery, she was                                                               
told  to  talk  to  a  specialist in  Anchorage.    She  made  an                                                               
appointment; this  specialist told  her over  the phone  that she                                                               
should have an abortion, without  even examining her or reviewing                                                               
any  of her  medical records.   The  doctor's recommendation  was                                                               
based  on a  conversation  with  her where  she  related some  of                                                               
things that had been told to her  when she had an ultrasound.  Of                                                               
course,  the  term "abortion"  was  never  used; rather,  it  was                                                               
always "termination of pregnancy."   The reasons she was told she                                                               
should have an abortion were that  it would be too expensive, too                                                               
difficult  on  her  family,  and  life-endangering,  which  could                                                               
possibly leave her other children motherless.                                                                                   
                                                                                                                                
Number 0990                                                                                                                     
                                                                                                                                
MS. JOSLIN said  she found out through her own  research that her                                                               
life was in no danger.  She said  she was also told after she had                                                               
tests and met  with the doctor that their son  had a very serious                                                               
chromosomal  abnormality which  always  resulted in  death.   Ms.                                                               
Joslin found  out later from  information that the doctor  had in                                                               
her  office that  most do  die,  but not  all  die.   It is  very                                                               
different to find  out that 90 percent compared  with 100 percent                                                               
die.   After  she'd turned  down the  abortion several  times and                                                               
weeks  had passed,  she was  finally told  by the  specialist who                                                               
worked with  this doctor  that there was  a parent  support group                                                               
for  families  who  were  expecting   babies  with  these  health                                                               
problems.     She  called   an  800   number  and   got  valuable                                                               
information.   Ms. Joslin said  if this  bill had been  in place,                                                               
another woman  in her place  wouldn't have  to go out  and search                                                               
for all this information.  It  would have been part of the packet                                                               
and  that 800  number  would  have been  given  to  her up  front                                                               
instead of having  to wait weeks.  She said  that the information                                                               
she  obtained  from  the  parent support  group  was  not  "rosy"                                                               
either; they were very straightforward  in their facts.  The fact                                                               
is, some of those children live.                                                                                                
                                                                                                                                
Number 1063                                                                                                                     
                                                                                                                                
MS. JOSLIN said none of the  parents who have children with these                                                               
abnormalities regretted  giving life to  their children.   It was                                                               
very helpful  to see  pictures of what  these children  look like                                                               
and  read  in  detail  some  difficulties  encountered  by  other                                                               
families.   When  her  son was  born full  term,  because of  the                                                               
support of that  parent group and the  information they provided,                                                               
she was able  to know what some  of the issues were  going to be.                                                               
Isaiah had  feeding issues  that would come  up at  the hospital.                                                               
Sometimes it  surprised the staff how  well she was able  to deal                                                               
with  it because  she already  knew what  to expect.   When  they                                                               
found out  Isaiah was  probably deaf, she  was not  "freaked out"                                                               
because she  had already read  ahead of  time that many  of these                                                               
children are deaf.                                                                                                              
                                                                                                                                
MS. JOSLIN said if this  bill were passed, the information should                                                               
be made  available for  parents who  have children  with physical                                                               
abnormalities, women who are unwed,  and women with financial and                                                               
emotional problems.   There are  so many pregnancy  resources out                                                               
there; she said  she believes it would be difficult  for a doctor                                                               
to keep up with all of it.   She suggested that it would be great                                                               
for the  state to take  over the responsibility of  updating that                                                               
web site  and ensuring that  women have information  available to                                                               
make an informed decision.                                                                                                      
                                                                                                                                
MS.  JOSLIN told  the committee  that it  is not  right that  the                                                               
medical professionals who  have a very biased  opinion about what                                                               
was  best   for  her  and   her  family  provided   very  slanted                                                               
information  and left  out information  because  they wanted  one                                                               
outcome.   The doctors  made it  very clear  that they  were very                                                               
disappointed  and confused  about why  she would  choose to  give                                                               
life to her  son.  Isaiah was  born full term and  lived 30 days.                                                               
It was  the hardest, sweetest thing  she has done and  she has no                                                               
regrets.    She watched  her  son  die in  her  arms,  and it  is                                                               
something  that has  cemented in  her heart  and mind  that women                                                               
must be given all the information.                                                                                              
                                                                                                                                
Number 1184                                                                                                                     
                                                                                                                                
MS. JOSLIN  urged the committee to  have respect for women.   She                                                               
said  it  isn't  demeaning  and isn't  harassment  to  give  more                                                               
information.  She urged the committee to pass this bill.                                                                        
                                                                                                                                
CHAIR WILSON informed the committee that testimony would                                                                        
continue on Thursday.  [HB 292 was held over.]                                                                                  
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no further business before the committee, the House                                                                 
Health, Education and Social Services Standing Committee meeting                                                                
was adjourned at 5:10 p.m.                                                                                                      

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