Legislature(2003 - 2004)
05/06/2003 03:11 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
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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