Legislature(2001 - 2002)
03/29/2001 03:05 PM House HES
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES
STANDING COMMITTEE
March 29, 2001
3:05 p.m.
MEMBERS PRESENT
Representative Fred Dyson, Chair
Representative Peggy Wilson, Vice Chair
Representative John Coghill
Representative Gary Stevens
Representative Sharon Cissna
MEMBERS ABSENT
Representative Vic Kohring
Representative Reggie Joule
COMMITTEE CALENDAR
HOUSE BILL NO. 160
"An Act requiring the reporting of induced terminations of
pregnancies."
- HEARD AND HELD
HOUSE BILL NO. 164
"An Act prescribing the rights of grandparents related to child-
in-need-of-aid hearings; and amending Rules 3, 7, 10, 15, and
19, Alaska Child in Need of Aid Rules."
- HEARD AND HELD
HOUSE BILL NO. 142
"An Act relating to the Alaska temporary assistance program; and
providing for an effective date."
- SCHEDULED BUT NOT HEARD
PREVIOUS ACTION
BILL: HB 160
SHORT TITLE:REPORTING OF ABORTIONS
SPONSOR(S): REPRESENTATIVE(S)COGHILL
Jrn-Date Jrn-Page Action
03/09/01 0514 (H) READ THE FIRST TIME -
REFERRALS
03/09/01 0514 (H) HES, JUD, FIN
03/22/01 0697 (H) COSPONSOR(S): JAMES, KOTT
03/23/01 0711 (H) COSPONSOR(S): WILSON, MEYER
03/29/01 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 164
SHORT TITLE:GRANDPARENTS' RIGHTS REGARDING CINA
SPONSOR(S): REPRESENTATIVE(S)DYSON
Jrn-Date Jrn-Page Action
03/09/01 0515 (H) READ THE FIRST TIME -
REFERRALS
03/09/01 0515 (H) HES, JUD, FIN
03/27/01 (H) HES AT 3:00 PM CAPITOL 106
03/27/01 (H) Heard & Held
03/27/01 (H) MINUTE(HES)
03/29/01 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
DANIELLE SERINO, Staff
to Representative John Coghill
Alaska State Legislature
Capitol Building, Room 102
Juneau, Alaska 99801
POSITION STATEMENT: Testified on behalf of the sponsor of HB
160.
KAREN PEARSON, Director
Division of Public Health
Department of Health & Social Services
PO Box 110610
Juneau, Alaska 99811
POSITION STATEMENT: Answered questions on HB 160.
RANDALL LORENZ, Staff
to Representative Fred Dyson
Alaska State Legislature
Capitol Building, Room 104
Juneau, Alaska 99801
POSITION STATEMENT: As committee aid, answered a question
concerning language on HB 160.
MARY DYE
8000 North Douglas Highway
Douglas, Alaska 99824
POSITION STATEMENT: Testified on behalf of herself on HB 160.
ANNA FRANK, Executive Director
Planned Parenthood
9300 Arlene
Anchorage, Alaska 99515
POSITION STATEMENT: Testified on behalf of herself and Sharon
Smith on HB 160.
JENNIFER RUDINGER, Executive Director
Alaska Civil Liberties Union
PO Box 201844
Anchorage, Alaska 99520
POSITION STATEMENT: Testified on HB 160.
IDA BARNACK, Alaskans for Life Incorporated
8292 Garnet Street
Juneau, Alaska 9801
POSITION STATEMENT: Testified in support of HB 160.
SID HEIDERSDORF
PO Box 658
Juneau, Alaska 99801
POSITION STATEMENT: Testified on behalf of himself on HB 160.
WES KELLER, Staff
to Representative Fred Dyson
Alaska State Legislature
Capitol Building, Room 104
Juneau, Alaska 99801
POSITION STATEMENT: Testified on behalf of the sponsor of HB
164.
BETTY SHORT, President
Grandparents Rights Organization
3705 Arctic Boulevard
Anchorage, Alaska 99503
POSITION STATEMENT: Testified in support of HB 164.
LINDA SLONE
Grandparents Rights Organization
6400 Reed Lane
Anchorage, Alaska 99503
POSITION STATEMENT: Testified in support of HB 164.
JOANNE GIBBENS, Program Administrator
Division of Family & Youth Services
Department of Health & Social Services
PO Box 110630
Juneau, Alaska 99811
POSITION STATEMENT: Testified in support of HB 164.
ACTION NARRATIVE
TAPE 01-38, SIDE A
Number 0001
CHAIR FRED DYSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:05 p.m.
Members present at the call to order were Representatives Dyson,
Wilson, Coghill, Stevens, and Cissna.
HB 160-REPORTING OF ABORTIONS
CHAIR DYSON announced that the first item of business would be
HOUSE BILL NO. 160, "An Act requiring the reporting of induced
terminations of pregnancies." He stated that it was his
intention to not move the bill that day.
CHAIR DYSON said currently abortion clinics are not licensed or
inspected like other surgery centers, and he would like to spend
a couple of days investigating that and then decide whether or
not to add those facilities to the list of those that are
licensed and inspected.
Number 0220
REPRESENTATIVE COGHILL speaking as the sponsor of HB 160, stated
that it is his intention to amend the bill. He remarked that
there is no monitoring of abortions in Alaska; however, the
majority of states do monitor, and the Centers for Disease
Control [and Prevention] (CDC) has a template for doing this.
He remarked that there is a heavily polarized discussion [on
abortions] in America; however, this would help tabulate what is
going on in society, notwithstanding the debate. This would be
modeled after the federal guidelines for these reports and would
then be established in [Alaska's] records with the National
Center for Health Statistics. He concluded that he would like
this to be reported to Vital Statistics with some modification.
Number 0427
DANIELLE SERINO, Staff to Representative John Coghill, Alaska
State Legislature, came forth on behalf of the sponsor of HB
160. She stated:
Currently, Alaska does not collect any abortion
information. Alaska and California are the only two
states that do not collect any information, and
California currently doesn't because of a lawsuit that
put their current laws in limbo.
Both sides to the abortion debate recognize the need
for abortion information and statistics. ...
Currently, abortion data in the United States is
collected and evaluated by the Centers for Disease
Control [and Prevention] and the Alan Guttmacher
Institute. Data is used in conjunction with birth
data and fetal death computations to estimate
pregnancy rates and other maternal health rates.
MS. SERINO stated that the bill is designed to go alongside the
federal guidelines for induced termination of pregnancy
reporting. On page 1, [lines 11-12] it states, "the physician
shall submit the report required under this section within three
days after the induced termination of pregnancy is completed."
She explained that one of the proposed amendments [to be
provided in future proposed committee substitute (CS)] would
increase that to one month in order to give physicians enough
time to comply with that requirement. She stated that there
will be another amendment on page 2, [paragraph] (2), following
line 8, that will address ectopic and non-uterine pregnancies to
be excluded from reports of induced termination of pregnancies.
Number 0662
REPRESENTATIVE CISSNA asked if those pregnancies are reported at
all.
MS. SERINO responded that she thinks the [Department of Health &
Social Services] could better answer that. She stated that she
thinks it would be a voluntary reporting by the physician.
Number 0692
KAREN PEARSON, Director, Division of Public Health, Department
of Health & Social Services (DHSS), answered that ectopic and
non-uterine pregnancies are not considered to be pregnancies
because they are not viable. The only way to actually carry a
pregnancy to term is in the uterus.
REPRESENTATIVE CISSNA stated that she could see some
applicability if [DHSS] were collecting data on fertility.
Number 0723
MS. SERINO continued, stating that the entire section on page 2,
line 23, through page 3, line 8, will probably be deleted. She
explained that in discussing this with [DHSS], it would be hard
to determine any medical complications at that point. Many
complications that might result from an abortion would be more
visible in following visits to a physician, rather than
immediately after the termination procedure.
CHAIR DYSON stated that he will require some convincing on that.
He said he is particularly concerned with perforated uteruses,
fetal parts that are left in the uterus, and resulting
infections. He added that he would think the clinic would know
of the 30-day reporting cycle.
MS. SERINO responded that he has a valid concern.
REPRESENTATIVE STEVENS asked if any of the issues referred to on
page 2, line 23, through page 3, line 8, are in the federal
handbook [provided in the committee members' packets].
MS. SERINO answered that they are not, and that is the reason
why they are included separately [in the bill]. She continued,
stating that the main purpose of Sections 2, 3, and 4 on page 3
is to protect patients' privacy. Since Alaska is a very unique
state and made up of rural and urban areas, it is very possible
for women in the rural areas to be easily identified through a
report.
Number 0946
CHAIR DYSON, referring to page 3, line 10, asked, "Why wouldn't
the bureau [of vital statistics] make the data available for
research purchases? Why should it be may instead of will? What
kind of research projects wouldn't this public organization want
to make the information available to?"
MS. SERINO responded that she is not certain as to which
[research projects]. She stated that this focuses on individual
reports. Therefore, if the [DHSS] is going to provide an annual
report with all of the data compiled, a research organization
would be able to access the data instead of the individual
reports, which could possibly be a violation of patient
confidentiality.
CHAIR DYSON asked, if he were to look at AS 18.50.310(b) in its
context, whether he would know that subsection (b) is talking
about an individual person.
MS. SERINO replied yes, it would be about an individual report
from which an individual may be identified.
CHAIR DYSON asked if the same is true for subsection (e), lines
13 and 14.
MS. SERINO answered yes.
Number 1050
REPRESENTATIVE WILSON asked if there is a safeguard already in
place for rape.
MS. SERINO answered that she is not positive.
Number 1091
REPRESENTATIVE CISSNA noted that on page 1, line 7, it states,
"The report may not contain the name of the patient". She said
she thinks it would be more reasonable to say, "The report shall
not contain the name of the patient". She asked if there is a
reason why "may not" instead of "shall not" appears.
CHAIR DYSON remarked that it is his guess that "may not" is an
imperative.
RANDALL LORENZ, Staff to Representative Fred Dyson, Alaska State
Legislature, speaking as the committee aid for the House Health,
Education and Social Services Standing Committee, stated that he
had talked with Legislative Legal [and Research Services] on
this issue for a prior bill and was told that "shall not" is not
accepted in any legislation. According to [Legislative Legal
and Research Services], "may not" means the same thing [as
"shall not"] under the Alaska statutes.
Number 1170
MS. SERINO continued, stating that on page 3, Section 5, the
"fetal death" definition was amended so that induced termination
of pregnancy would be excluded from that definition. This would
draw a defining line between fetal death and induced
terminations of pregnancy.
CHAIR DYSON asked if on page 3, line 23, the inclusion of
"complete expulsion" allows for the life of the child to be
terminated just before the last bit of expulsion.
MS. SERINO answered that that wasn't the intention, and that the
definition is as it currently is in Alaska statute. She
concluded that on page 4, Section 6 amends the vital statistics
definition to include induced termination of pregnancy, and
Section 7 adds a definition for induced terminations of
pregnancy.
Number 1309
REPRESENTATIVE WILSON asked if the definition on page 4, line 5,
is used anywhere else.
MS. SERINO replied that the definition is standard throughout
all of the states.
REPRESENTATIVE STEVENS asked if virtually everything in the bill
is a reflection of the federal handbook.
MS. SERINO answered that the bill, as it is currently drafted,
calls for reporting requirements other than the federal
guidelines. With the [future] proposed CS, it would be based
solely on the guidelines of the federal requirements.
REPRESENTATIVE COGHILL commented that he wanted to provide the
intention [of the bill] before hearing public testimony. He
stated that there are several issues that are difficult to
describe. For example, many people won't admit to [having been
raped].
Number 1457
MS. PEARSON stated that it is her understanding that the intent
of HB 160 is to require all providers to report induced
termination to [the Division of Public Health]. She said:
While we do not oppose mandatory reporting of induced
pregnancy terminations, according to the U.S. standard
report, as described and discussed earlier, we do have
some concerns about certain requirements in HB 160.
... [Sub]section (a) [in Section 1] asks for medical
complications resulting from the pregnancy
termination.
Overall, there's an overarching concern here that any
numbers that are collected through this process have
meaning and validity so that policymakers and people
who are concerned can make decisions on the basis of
the information collected. We're a bit concerned here
that collecting this information would be of minimal
value since the complications that would be likely to
be reported here would be those that would occur only
at the time of the induced terminations, or shortly
thereafter,, due to the fact that in Alaska, at the
current time, there are very limited numbers of
providers and they are not in the rural areas. So it
is quite possible that women could come in to the more
urban settings, have an induced termination, and if
there were any follow-up problems, they would be seen
by a different provider back in their home community
who would not be filing a report of an induced
termination. So there would never be any connection
between those. While you may get some information
here, it would be a less-than-complete picture.
CHAIR DYSON asked, "So what?"
MS. PEARSON responded that part of the reason is to understand
whether there are complications associated with [induced
terminations], and to have the caveats to explain in any report
that these numbers would likely only address those occurring
within 24 or 48 hours. She stated that in other cases, if the
provider was someone whom a woman came to for ongoing care, then
any problem that might come up would be reported in that 30-day
period. She added that there would be complete information on
some women, incomplete information on other women, and overall
it would be hard to look at aggregate statistics and know what
they revealed.
CHAIR DYSON asked, "Why wouldn't you want to have ... some
information?"
MS. PEARSON answered that it comes back to how people use
information and knowing that partial information is sometimes
more problematic than none.
Number 1643
CHAIR DYSON suggested that an asterisk could be inserted saying,
"Everybody pay attention, this is incomplete information."
However, he said, the interest is protecting public health. He
stated that there is a case on the national level in which 85 or
87 women who had very serious complications sued a provider of
these services. He asked Ms. Pearson why her department
wouldn't want to know that.
MS. PEARSON answered that [the Division of Public Health] would
want to know that kind of information; however, she said she is
not sure this is the right vehicle to get that information.
CHAIR DYSON asked what the right vehicle would be.
MS. PEARSON responded that she thinks [the Division of Public
Health] could look, for example, at hospital discharge data. If
someone was looking at serious complications, that person would
likely be looking at a hospitalization.
CHAIR DYSON asked if that information is received now.
MS. PEARSON answered that Alaska does not have a hospital
discharge data system.
Number 1708
CHAIR DYSON remarked that it is his understanding that part of
the way this industry has protected itself is that virtually all
of these malpractice cases are being settled out of court, which
is why there are no public records.
MS. PEARSON asked Chair Dyson if he understands why [the
Division of Public Health] would want to know that there is a
complete picture for health purposes and policymaking.
CHAIR DYSON stated, "Your testimony ... makes me think that
you're more interested in reports than saving the life and
health of people."
MS. PEARSON responded that [the Division of Public Health] is
concerned and wants to make decisions that reflect what the
reports say.
REPRESENTATIVE CISSNA stated that she occasionally goes to the
doctor and occasionally has procedures done. She said she is
mystified by the amount of forms, with duplicate information,
that have to be filled out. She added that it constantly makes
her mindful of the fact that [the legislature's] job is to
protect the public's health, but also to remember that people's
time is precious and that duplication in collection of material
needs to be avoided.
Number 1833
REPRESENTATIVE WILSON shared that someone she knows found out
she was going to have twins. A week later she started having
complications and had a miscarriage. About six weeks later the
women was pregnant again, and a few weeks after that she started
getting sick and had problems. The woman found out that with
the first twins everything had not been removed; as a result,
this terminated her second pregnancy. The women received a D&C
(dilation and curettage) in a doctor's office; therefore, there
were no [hospital] reports. Representative Wilson stated that
if this were an abortion, the same thing could have happened and
the reports would not show up.
MS. PEARSON responded that Representative Wilson is correct.
She stated that the situation that she described would not show
up on an induced pregnancy termination because it is a
miscarriage situation and has to do more with practice issues.
CHAIR DYSON shared that [he knows of] a woman who had an
abortion and didn't know that she was [carrying] twins. A few
weeks later she was really sick. When she went back to the
doctor she found that she had an almost five-month-old fetus
with both legs and part of one arm gone. He added that "we"
need that kind of information.
MS. PEARSON responded that the point that Representative Wilson
brought up is the need for information about practice in
general. She stated that [Representatives Wilson and Dyson were
talking about] two different situations: one is an induced
termination, and the other is a miscarriage that wasn't handled
properly.
CHAIR DYSON remarked that [the committee] will look forward to
helping tie the hospital records that deal with complications
from induced terminations to individual practitioners.
MS. PEARSON stated, "In public health, what we strive to do is
get information from specific situations so that we can take the
learning statewide for public practices. We don't get involved
with the one-to-one patient-practice relationships."
CHAIR DYSON stated that he appreciates that [and would like to
know] how the medical practicing board finds out about
incompetence and malpractice.
MS. PEARSON responded that that is outside the purview of public
health. She continued, stating that subsection (b) asks if a
fetal anomaly was discerned, and if so, what type. She
explained that when pregnancy terminations are induced early, it
is very difficult to discern the anomalies without expensive
genetic or laboratory testing. Therefore, there would only be
information on induced terminations when the fetus was at such a
developmental stage that the provider could visibly discern any
anomalies. She added that as a result, there would be
incomplete information.
CHAIR DYSON remarked that if it is possible to find out that
some of the diagnostic techniques being used prenatally have an
error range he thinks that is useful information.
Number 2105
MS. PEARSON stated that if this bill passes, [the Division of
Public Health] would not be going back and tying testing to the
clients. Everything that would be coming to Vital Statistics
would be a numbered document; the woman who has the procedure
will not be named.
REPRESENTATIVE COGHILL remarked that one of the things being
looked for is the times when people are presented with an
anomaly within the pregnancy and are encouraged to have an
abortion. He stated that as far as public health, this bill is
looking for the practice that is actually happening and whether
an anomaly was part of that.
MS. PEARSON responded that there would be some identification of
fetal anomalies, but it couldn't be extrapolated from that data
that a certain percent of induced terminations were fetal
anomalies. She stressed that this is why she cautions about
having incomplete data. Those in the public health field, she
said, have the responsibility to let lawmakers know where the
difficulties would be in using the information that would be
produced by such a system.
Number 2194
REPRESENTATIVE CISSNA stated that she has heard that one of the
hardest things to prove legally is intent.
REPRESENTATIVE WILSON asked Representative Coghill if he is
looking for whether [a doctor] could tell from an ultrasound
that something was wrong and therefore the woman decided to
terminate the pregnancy.
REPRESENTATIVE COGHILL responded that that would be a
discernible fetal anomaly.
REPRESENTATIVE WILSON asked if he really wants to know what [the
anomaly is] and if [the anomaly] is the reason [for the
termination].
REPRESENTATIVE COGHILL answered that he would be looking for the
anomaly. He stated that he understands the incompleteness of
it; however, he said he is throwing out questions that
continually come to his mind when looking for what is actually
happening and not the motive.
Number 2276
CHAIR DYSON stated that he remembers when no one knew that
thalidomide, which was supposed to be a wonder drug, was causing
so many problems until finally some folks started looking at it.
Also, he said, Fetal Alcohol Syndrome [wasn't recognized] until
finally someone who had seen quite a few kids who looked
different started pulling that information together. He stated
that he thinks a pattern of fetal abnormalities could be very
interesting and prevent some huge tragedies.
REPRESENTATIVE CISSNA remarked that she could see there would be
real purpose in knowing about the pattern of abnormalities in
pregnancies.
MS. PEARSON responded that currently [the Division of Public
Health] has in place the Maternal Infant Mortality Review
Committee, which reviews all maternal and infant deaths. [The
committee] collects all of the possible information about what
happened during the pregnancy and determines exactly the kinds
of things [that could have caused the death].
TAPE 01-38, SIDE B
Number 2356
MS. PEARSON continued, stating that [the Division of Public
Health] is very concerned and knows that the sooner patterns
[are detected], the more can be done. She shared that one of
the best examples of that, which was consistent with national
information, was when a very large percentage of infants who had
died from SIDS (Sudden Infant Death Syndrome) were found dead on
their "tummies." After an educational campaign [about not
placing infants on their stomachs] was launched, there was a
dramatic decrease [in SIDS].
CHAIR DYSON remarked that if "you're" going to start tracking
what has caused fetal deaths, some of the induced termination of
pregnancies will be because some kind of amniocentesis or
ultrasound had showed defects. Having this information,
together with [information on] fetuses that died naturally,
could be helpful.
REPRESENTATIVE WILSON referred to page 2, [subparagraph] (B),
regarding whether a fetal abnormality was discernible, and noted
that [subparagraph] (C) asks for the reason given by the
pregnant woman. She stated that one reason could be because
there was a fetal abnormality. She suggested that that could be
one of the reasons [listed under subparagraph (C)].
MS. PEARSON stated that [subparagraph] (C) asks for the reason
for the termination to be reported. In response to
Representative Wilson's remarks, she said this is very personal
information that may appear to intrude on the woman's privacy.
Several of the states that have the [induced termination
reporting] had started by asking this information. In more than
90 percent of the reports, it was listed as a psychological
factor; therefore, almost all states have dropped any requests
in this area, based on a number of issues of why women would not
give any other reason. For example, sometimes incest victims
are very reluctant [to give information] if their pregnancy
resulted from that, because of all of the possible
ramifications. She stated that the likelihood of this being
left in, and of meaningful information [being collected] that
reflects the true reasons for that choice, is pretty limited and
very unlikely.
Number 2214
CHAIR DYSON asked, "How are you going to get at the Hyde
amendment requirements for when [the] public pays for abortion
for a reportedly indigent person if you don't ask this
question?"
MS. PEARSON replied that the definition that is operative in
Alaska is called a therapeutic abortion. The meaning of this
has to do with the health and life of the mother and the
physical and psychological well-being of the woman. She stated
that these are the types of questions a provider would have to
ask to determine if it was a therapeutic abortion.
CHAIR DYSON asked if [those questions] are asked for those
reasons, why they can't be put on the report [mentioned in the
bill.]
MS. PEARSON answered that this report asks for a lot of other
things such as whether [the woman is having an abortion] for
economic reasons, because of social circumstances, or as the
result of a rape or incest. She stated that it goes beyond the
health and well-being of a woman.
CHAIR DYSON asked if he could infer that Ms. Pearson would not
object to a question that only went to the life and health [of
the woman].
MS. PEARSON responded no, that she thinks that has to be asked
anyway.
CHAIR DYSON asked Ms. Pearson to go through all of the sub-
subparagraphs under [subparagraph] (C). He asked if she would
object to [sub-subparagraph] (iii).
MS. PEARSON responded that this isn't her personal feeling, but
she is worried about getting information that has meaning for
[the legislature and the Division of Public Health]. She stated
that in the doctor-patient relationship there are going to be a
variety of questions asked, and there will not be one question
that leads a person to know if it's the overall health and well-
being of the woman. She asked, "What would be the benefit of
having information about whether it was a risk to the woman's
physical health or her mental health? Are you going to get
anything meaningful when you ask these questions [since they are
subjective]?"
Number 2059
CHAIR DYSON remarked that [Ms. Pearson] point was well taken.
He stated that his guess is that some information properly
understood is better than no information. He said if hundreds
of children per year are being terminated because of the
mother's health, maybe that says something about the support
services that need to be provided to young women of childbearing
age.
REPRESENTATIVE CISSNA stated:
The thing that strikes me on this is that we've gone
to a lot of lengths, and I don't disagree with it, to
remove, for instance, putting social security numbers
on a number of things - on things that there's no
really good reason for. And by having the social
security number on there, if somebody really wants to,
they could find out a lot about us - and some personal
things about us. That is a movement which I applaud.
I think that privacy is something that we should fight
for, because everything in our system right now is
fighting against it. And young women or middle-aged
women going through these things - it's going to be
meaningful for them, and it's a private issue. ... Our
personal bodies are private.
REPRESENTATIVE COGHILL responded that he took great lengths to
do that in this bill - to protect that privacy - while still
trying to find out what is actually happening with the
terminations of pregnancies.
Number 1948
MS. PEARSON stated that her final concern is with subparagraph
(E) [on page 3], "whether the termination was paid for through
medical assistance". She remarked that [the Division of Public
Health] already has that information from the Medicaid claims
tapes. Therefore, if this is passed, [the Division of Public
Health, at the end of every year, would go to Medicaid, ask how
many [abortions] were paid for, and put that into the report.
If the provider is asked to report this information, then it
will no longer just be the provider filling it out. [The
report] would have to go into [the provider's] financial
records, which adds quite a burden.
REPRESENTATIVE COGHILL responded that he agrees with Ms. Pearson
on this.
Number 1876
MARY DYE came forth to testify on behalf of herself and stated:
It seems like there are a lot of people here who are
taking a step in the right direction, but they are
wanting to make sure, when they take this step, "I am
in favor of this step." But they want to make sure
that they don't do anything that also creates problems
for women. This issue really is a women's health and
a public health issue. In my opinion, you never can
make a mistake gathering information - gather it. And
you will never have complete information. Yes, that
would be wonderful. I can't imagine ever having
complete information on anything to make a
determination. A lot of times you just have to gather
what you can in order to make that determination. But
information is a good thing. The thought, to me, of
not getting information because it wouldn't be
complete doesn't make sense.
Number 1752
ANNA FRANK, Executive Director, Planned Parenthood, testified
via teleconference. She first read to the committee testimony
prepared by Sharon Smith, M.D.:
I am astounded that Alaska is currently the only state
that does not require mandatory reporting of
abortions. These statistics are essential. The
National Center for Health Statistics, Centers for
Disease Control, and U.S. Department of Health and
Human services have developed a standard report of
induced termination of pregnancy designed to be a
model for use by the states. If each state adopts
this standard report, there will be a uniform system
of reporting nationwide, which can yield very useful
and important information to be used in policymaking
and assessment of current programs. I urge you to
adopt this reporting tool for use in Alaska.
Unfortunately, HB 160 - without the amendments, of
course, that you've discussed today - requires the
mandatory reporting of a different set of statistics,
and does not make use of the standard created by the
CDC. Many of the statistics required by HB 160 are,
frankly, inappropriate or irrelevant. The timetable
of required reporting is also very short and difficult
to comply with.
I urge you to oppose HB 160, and instead draft a bill
which would require reporting based on the model
provided by the CDC.
Number 1652
MS. FRANK testified next behalf of herself. She read her
testimony to the committee:
It may surprise you to know that Planned Parenthood of
Alaska is in support of requiring certain statistics
to be required of physicians performing abortions.
Indeed, knowing how many abortions are performed, the
age of people who receive abortions, and whether or
not they have children or have had other terminations
is information we can use to assess whether or not our
efforts to reduce abortion and provide family planning
services are working. And Alaska, we know now, is one
of the only states that does not currently have this
reporting requirement.
Sadly, however, we must oppose HB 160 as it is
currently drafted. And the reasons why, I believe,
Representative Coghill has addressed quite succinctly,
and we would support the amendments that he's
proposing. Again, I could call your attention to
Section 1(e)(2), where clearly the requirements are
beyond what the state has a compelling interest to
know. Why a woman needs or chooses to have an
abortion is really none of the state's interest, and
whether or not the termination is paid through
Medicaid is redundant. As Karen Pearson has pointed
out, physicians already file claims for Medicaid for
this procedure if it is therapeutic. So, this
information is readily available and should not be
required to be tracked more than once.
... I would like to call your attention to Section
1(b) ... as you propose changing the three-day
requirement to the one-month requirement. That is
also stated in lines 6 and 7, and should be changed
there as well. The three-day requirement, as it is
written in the draft that I have, is burdensome and
unprecedented. In many instances, the physician would
be unable to comply. This is because if a physician
were providing a medical abortion, known to be safer
and done earlier than a surgical abortion, it is
likely that the abortion would not be complete within
the specified three-day period. Again, what is
typical of other states is to require information on a
less-frequent basis.
We believe this bill, as written, is in violation of
the Alaska constitution. We would support the amended
bill that would require the information on a less-
frequent basis and that is actually similar to that of
the CDC requirements. And those requirements ...
include the patient's ID (identification), age,
marriage status, date of termination, residency
information - and I really appreciated the issue of
confidentiality for women in smaller rural towns in
Alaska - ... race, education, date of last menstrual
period, estimated gestation, previous pregnancies and
live births, other terminations, the type of
procedure, the name of the physician, and the name of
the person completing the report.
Again, Planned Parenthood of Alaska is pleased that we
may be able to know, by aggregate statistics,
information associated with induced abortion,
information on the characteristics of the women who
choose or need an abortion, and information on the
role that abortion plays in prevention of unintended
births as compared with contraception. The data
obtained are very important from both a demographic
and public health viewpoint.
Thank you for your time, and thank you for considering
to amend the bill as written to protect women's
privacy and keep the state's interest to that which
simply protects and promotes women's health.
Number 1532
CHAIR DYSON stated that it seemed in Ms. Frank's preliminary
remarks that part of her mission is to reduce the number of
abortions. He asked if it would be helpful to know the reasons
for the abortions in order to help reduce them.
MS. FRANK responded that [Planned Parenthood] believes that is
confidential and private information that a woman has a right to
keep private if she chooses to do so.
CHAIR DYSON asked Ms. Frank is she feels the same way about the
form that [Planned Parenthood] endorses, which asks when the
last period was, how many kids [the woman] has, her race, and
her education. He asked if those also are private information
that people have the right to not share.
MS. FRANK stated that he is correct and that they have the right
to not tell. Therefore, [Planned Parenthood] would have to take
the information that it can gain with a grain of salt. She
added that by collecting this information, [Planned Parenthood]
knows if the family planning programs are really working.
CHAIR DYSON asked if it is right to infer that Ms. Frank would
not object to this bill's asking for people to give some of this
additional information on a voluntary basis.
MS. FRANK responded that she would object to that. She said the
state really doesn't have an interest in knowing that specific
information. She added that since that information is collected
aggregately, it wouldn't be possible to tie this information to
the information that is required.
Number 1433
JENNIFER RUDINGER, Executive Director, Alaska Civil Liberties
Union (AKCLU), testified via teleconference. She stated that
she would like to thank Representative Coghill for a bill that
balances the interests in protecting patient privacy, as he has
proposed to amend it, with the public interest in collecting
aggregate data for statistical purposes. She remarked that she
would underscore Ms. Frank's recommendation on page 1, lines 6
and 7, for that three-day requirement, to be extended to
quarterly or, at the very least one month to match the one-month
extension for doctors. She said the three-day [requirement] is
in fact unworkable and overly burdensome. She added that if
[subsection] (e)(2) is deleted then [AKCLU] would not have a
constitutional problem with the bill.
MS. RUDINGER explained that doctors already do extensive
counseling with their patients in order to gain informed consent
prior to performing any medical procedures, including an induced
termination of pregnancy. Oftentimes in the doctor-patient
relationship, which the patient understands to be confidential,
this kind of information in [subsection] (e)(2) will come up.
There's a difference, as a woman, in being asked these questions
by a doctor with the understanding that it's confidential, as
opposed to being asked these questions by a doctor who then has
to turn around and report it to the government, even if the
woman's name isn't on it. This is where the Alaska constitution
privacy guarantee may be violated because the state would not be
able to show compelling interest in this subjective information,
which is not a fact like rape or the number of children.
Number 1204
REPRESENTATIVE COGHILL asked, if information with regard to the
timing of the abortion were asked, whether she thinks that would
be intrusive information.
MS. RUDINGER responded that she thinks that the CDC already
includes information about the day of the last period and an
estimate of gestation. She stated that the AKCLU does not have
a problem with what the CDC is already requiring or requesting
in the standard report of induced termination of pregnancy.
REPRESENTATIVE COGHILL stated that he knows that information is
already there; however, he is looking for parameters regarding
how [the legislation] can ask information in order to find out
what is happening.
MS. RUDINGER explained that the problem with [subsection] (e)(2)
is that, as a patient it's as though one is being asked to
justify a choice that is constitutionally protected. She stated
that the AKCLU does not have a problem in terms of the right to
privacy with factual information, such as gestation and rape.
Number 1095
REPRESENTATIVE COGHILL stated that he is looking for how to get
some of this subjective information. He asked if it is possible
to ask doctors to give a summation at the end of the year based
on their experience.
MS. RUDINGER responded that it depends on what the doctors are
going to do with the information. She stated that she thinks it
will depend on a lot of things such as the government's interest
in obtaining it; how the patients' rights of privacy are
protected; and if the means of obtaining it are narrowly
tailored and essential to achieving that compelling government
interest.
REPRESENTATIVE COGHILL remarked that he is going to take Ms.
Rudinger's testimony, along with Ms. Pearson's, and try to think
through what kind of parameters he can provide that are more
factual and less subjective.
MS. RUDINGER explained that she thinks the reasons that
[subparagraphs] (A) and (B) [on page 2] are constitutionally
problematic is because they are unworkable and are unnecessary
for vital statistics keeping. Especially in the cases of
medical abortions, the patient can't tell whether there is a
fetal anomaly.
CHAIR DYSON stated that Ms. Rudinger's testimony raises three
questions in his mind. He stated that "we" are virtually on the
edge now where a tissue sample from a terminated fetus could
provide DNA (deoxyribonucleic acid) information about birth
defects and abnormalities. Second, referring to page 3, line 4,
he asked Ms. Rudinger whether she was comfortable with
information on rape and incest.
MS. RUDINGER responded that that is the heart of the privacy
argument and is really problematic. It forces the woman to be
put in a position where she is asked for this information, not
as part of the doctor-patient relationship. but as part of the
interest in record keeping. She added that all of [subsection]
(e)(2) is either a violation of privacy or is superfluous and
redundant. She stated that in respect to fetal anomalies,
doctors say that in early abortions fetal anomalies are not
discernible.
Number 0811
IDA BARNACK, Alaskans for Life Incorporated, came forth in
support of HB 160. She stated that she would like to see on
page 2, under subsection (e)(2), the medical complications left
in even though it might be incomplete information. She said she
once worked for a government agency as a programmer and gave
information to various civic groups; if the information was
incomplete, she made a note that it was not complete. She
stated that [subparagraph] (B) [on page 2] can be put under
[subparagraph] (C) and perhaps just be reworded. She remarked
that she thinks [subparagraph] (C) should be left in because if
a woman has an abortion it would be good to know why. If they
are economic reasons, something should be done to relieve the
situation, and if they are social reasons, she said, perhaps
[the woman] could get help.
MS. BARNACK stated that she thinks [subparagraph] (D) could be
left in, but she thinks that [subparagraph] (E) could be taken
out because if [the information] is already reported under
another statute, any good programmer could go to that data file
and combine this information. She continued, referring to
Section 2, and stated that a program could give the information
without any indication of who it is by blanking out the social
security number and the name. Finally, she asked if a pregnancy
that results from incest is already reported.
CHAIR DYSON answered yes, that it is a crime and [if the victim
is a child, the physician] is required to report it to DFYS
(Division of Family and Youth Services) and the police.
MS. BARNACK asked if it would already be in the database.
CHAIR DYSON responded that it would be reported to the police
and this information would never become part of Ms. Pearson's
database.
MS. BARNACK stated that it would be good to know if the
termination of the pregnancy was due to incest.
Number 0422
SID HEIDERSDORF came forth to testify on behalf of himself in
support of HB 160. He stated that he was pleased to hear that
there is thought being given to "rewiring" inspections and
evaluations of all abortion facilities. When abortion was first
legalized, a tremendous effort was made to protect abortion
facilities from any kind of oversight. The result has been, he
said, that many women have paid the price because there are some
very shoddy abortion operators who are in it just for the
business. He remarked that he doesn't have any strong issues
about the three-day-versus-one-month issue; however, he said he
wonders why it would have to be a month. He stated that he
thinks information about ectopic and non-uterine pregnancies
should be collected because it relates to the fertility rate of
women. He noted that the rate of ectopic pregnancies has
skyrocketed following the legalization of abortion and is
clearly related.
MR. HEIDERSDORF stated that he thinks the sentence on page 2,
line 13, "After preparation of the annual report, the state
registrar shall destroy the reports received under this
section", is unwise because if there ever comes a time when
someone wants to look back, he or she might want to go to the
original source. He added that the report could be skewed and
prepared in such a way as to not reflect this data.
CHAIR DYSON asked if it would be sufficient if the reports were
stored electronically.
MR. HEIDERSDORF answered yes, because that would eliminate the
possibility of distortion of the report. He stated that with
regard to what would be included on this form, he would
encourage [the committee] not to drop medical complications. He
stated that this is at the heart of the reasons for looking at
the effects of abortions.
TAPE 01-39, SIDE A
MR. HEIDERSDORF stated that he thinks the gestatial age should
be included. He said many states are gathering more information
than what is on the federal form and he thinks that Alaska
should as well. He mentioned when Ms. Pearson had talked about
how early on 97 percent of the abortions were for psychological
reasons; he remarked that this would be correct because before
Roe v. Wade some states used this as a justification for
abortions. He added that he is sure this is the bottom line for
most people, and that if they had another reason, they would
gladly give it. He stated that he believes this is "kind of the
thing that says "I want an abortion for no reason.'"
Number 0215
MR. HEIDERSDORF stated that with regard to incest, for years the
argument was that abortion needed to be legalized because of
rape, incest, or the life of the mother. However, he asked:
Where was the concern about asking the individual
about incest or that individual revealing the fact of
incest before? Now we are concerned about whether
incest is one of the reasons why the abortion was
desired, and I would think that if it is suspected, at
any rate, that we would want to find whether it was
incest.
MR. HEIDERSDORF continued, stating that in reference to page 3,
line 11, he would think that the annual report for these induced
terminations should certainly be available for research
purposes. He added that he thinks it could be prepared in such
a way to protect people in small villages. In conclusion, he
asked what the definition of induced termination of pregnancy
means, which states, "the purposeful interruption of an
intrauterine pregnancy with the intention other than to produce
a live-born infant, and that does not result in a live birth".
REPRESENTATIVE COGHILL responded that it means the completion of
the termination.
MR. HEIDERSDORF said, "Let's say it does result in a live
birth."
REPRESENTATIVE COGHILL stated that it would not be, by
definition, a termination.
Number 0525
CHAIR DYSON suspended the hearing on HB 160.
[HB 160 was held over.]
HB 164-GRANDPARENTS' RIGHTS REGARDING CINA
CHAIR DYSON announced that the final order of business would be
HOUSE BILL NO. 164, "An Act prescribing the rights of
grandparents related to child-in-need-of-aid hearings; and
amending Rules 3, 7, 10, 15, and 19, Alaska Child in Need of Aid
Rules."
CHAIR DYSON, speaking as the sponsor of HB 164, explained that
about three years ago he worked on adding foster parents to the
list of people who had the right to be heard in CINA (child-in-
need-of-aid) case hearings, which is what HB 164 is trying to
do. He noted that [grandparents] are not parties in a legal
sense.
Number 0645
WES KELLER, Staff to Representative Fred Dyson, Alaska State
Legislature, gave the sectional analysis of the bill:
Section 1 inserts "grandparents" into the list of
those who must receive a notice of court proceeding
that could result in the termination of the rights and
responsibilities for CINA kids - to determine whether
or not they're CINA kids. ...
Section 2 specifies that the department will give
notice to the grandparent if the grandparent has
contacted the department and has provided evidence of
being a grandparent and a current address, or if the
department is aware that there is a grandparent. It
leaves it so the department does not have to seek out
every grandparent that might exist. ...
Section 3 requires the grandparent notification when
there is an informal court hearing related to custody
and gives them the right to be heard in that context
with the parent that tried, the foster parents and
everybody else.
Section 4, then, requires grandparent notification for
permanency hearings. ... And Section 5 amends the
Court Rules 3, 7, 10, 15, and 19.
MR. KELLER explained that [Court] Rule 17 was missed; therefore,
there is a proposed amendment that addresses this. The first
part of the amendment includes the actual rule in the bill, and
the second part makes grandparents aware of the predisposition
report.
Number 0835
BETTY SHORT, President, Grandparents Rights Organization,
testified via teleconference. She stated:
We are very pleased with the HB 164, which we feel is
in the best interest of the child. The best interest
of the child is our main concern. Most grandparents
are a stable unit for these children, and when they
are torn from their immediately family by strangers,
it's very devastating to them, and a familiar face of
a grandparent would be very welcome. Being put with
strangers, we feel, is mentally and emotionally
upsetting. Plus, it costs money for foster care,
whereas a lot of times the grandparents could take
them in without pay or at least till the situation got
a little more resolved. And it should take only 48
hours, according to DFYS [Division of Family and Youth
Services], to investigate a grandparent or
grandparents, but that investigation doesn't always
protect the children. ...
Division of Family and Youth Services, actually, on
their own could recognize and work with the
grandparents. It would sure make their job, we think,
a lot easier. But instead they have chosen to tell us
that we have no rights and that we are nothing more
than strangers and that we are not a party to the
case. ... According to Alaska Statute [AS] 25.05 they
recognize the grandparents' rights. AS 47.14.100(e)
(1) provides that the state department cannot place a
child in foster care if a blood relative [requests]
placement. And AS 47.10.080(p) provides the
department may deny visitation to parents or guardians
or family members only if there is clear and
convincing evidence that it is not in the best
interest of the child.
LINDA SLONE, Grandparents Rights Organization, testified via
teleconference. She stated:
I am the parent of four children, adoptive parent of
three of those children, and a grandparent. As a
grandparent I ask you to please pass HB 164. It is
vitally important to the safety and well-being of our
grandchildren. Our grandchildren are extensions of
ourselves - put simply, one more for us to love.
Grandparents are an integral part of the family and
they need to be involved in that process. When
grandparents are willing and able to step up to be
caretakers for their offspring, the state and the
court system should be required to allow that to
happen. The best hope for providing for the children
is the family or extended family rather than the
system. In order to have the best interest of the
child in mind, you first need to know what the best
interests are, and you could always get that from the
grandparents.
Number 1120
JOANNE GIBBENS, Program Administrator, Division of Family &
Youth Services (DFYS), Department of Health & Social Services,
came forth in support of HB 164 as it currently stands. She
said [DFYS] would have some concern about the amendment in
regard to the predisposition report, not in regard to
notification of the hearing. The predisposition generally goes
to the parties only, and this piece of legislation does not make
grandparents parties in terms of [Court] Rule 2, which legally
defines who the parties of the case are. She explained that the
predisposition report often contains confidential information
regarding the parents, such as extensive mental health
histories.
CHAIR DYSON stated that he is not going to pass [the bill] out
today and will allow [DFYS] to work that issue out.
ME. GIBBENS added that [DFYS] had some initial concerns about
grandparents who potentially had a [mental health] history, but
she said she thinks that is already covered in the requirement
regarding the hearing's being in the best interest of the child.
[HB 164 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 5:02 p.m.
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