Legislature(2017 - 2018)CAPITOL 106

04/19/2018 03:00 PM HEALTH & SOCIAL SERVICES

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Audio Topic
03:04:43 PM Start
03:05:17 PM SB198
05:13:19 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Bills Previously Heard/Scheduled TELECONFERENCED
+= SB 198 UAA LONG-ACTING CONTRACEPTION STUDY TELECONFERENCED
Heard & Held
-- Public Testimony --
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         April 19, 2018                                                                                         
                           3:04 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Ivy Spohnholz, Chair                                                                                             
Representative Tiffany Zulkosky, Vice Chair                                                                                     
Representative Sam Kito                                                                                                         
Representative Geran Tarr                                                                                                       
Representative David Eastman                                                                                                    
Representative Jennifer Johnston                                                                                                
Representative Colleen Sullivan-Leonard                                                                                         
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Matt Claman (alternate)                                                                                          
Representative Dan Saddler (alternate)                                                                                          
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
SENATE BILL NO. 198                                                                                                             
"An Act relating to a study of the effectiveness and cost of                                                                    
providing long-acting reversible contraception to women with                                                                    
substance abuse disorders."                                                                                                     
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: SB 198                                                                                                                  
SHORT TITLE: UAA LONG-ACTING CONTRACEPTION STUDY                                                                                
SPONSOR(s): SENATOR(s) KELLY                                                                                                    
                                                                                                                                
02/19/18       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/19/18       (S)       FIN                                                                                                    
03/26/18       (S)       FIN AT 9:00 AM SENATE FINANCE 532                                                                      
03/26/18       (S)       Heard & Held                                                                                           
03/26/18       (S)       MINUTE(FIN)                                                                                            
04/03/18       (S)       FIN AT 1:30 PM SENATE FINANCE 532                                                                      
04/03/18       (S)       Moved SB 198 Out of Committee                                                                          
04/03/18       (S)       MINUTE(FIN)                                                                                            
04/04/18       (S)       FIN RPT 4DP 1NR                                                                                        
04/04/18       (S)       DP: MACKINNON, BISHOP, VON IMHOF,                                                                      
                         STEVENS                                                                                                
04/04/18       (S)       NR: HOFFMAN                                                                                            
04/09/18       (S)       TRANSMITTED TO (H)                                                                                     
04/09/18       (S)       VERSION: SB 198                                                                                        
04/11/18       (H)       READ THE FIRST TIME - REFERRALS                                                                        
04/11/18       (H)       HSS, FIN                                                                                               
04/17/18       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
04/17/18       (H)       Heard & Held                                                                                           
04/17/18       (H)       MINUTE(HSS)                                                                                            
04/19/18       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
HEATHER CARPENTER, Staff                                                                                                        
Senator Pete Kelly                                                                                                              
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented SB 198 on behalf of the bill                                                                   
sponsor, Senator Kelly.                                                                                                         
                                                                                                                                
WILLIAM TRAWICK, Advanced Nurse Practitioner                                                                                    
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified regarding the NEST/NAS program.                                                                
                                                                                                                                
MARILYN PIERCE-BULGER, Owner                                                                                                    
FASDx Services, LLC                                                                                                             
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified during discussion of SB 198.                                                                   
                                                                                                                                
ROBERT BOECKMANN, PhD                                                                                                           
Chair, Institutional Review Board (IRB)                                                                                         
University of Alaska Anchorage                                                                                                  
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified during discussion on SB 198.                                                                   
                                                                                                                                
JEANNE GERHARDT-CYRUS                                                                                                           
Governor's Council on Disabilities and Special Education                                                                        
Kiana, Alaska                                                                                                                   
POSITION STATEMENT:  Testified during discussion of SB 198.                                                                   
                                                                                                                                
ELLEN HODGES, MD                                                                                                                
Bethel, Alaska                                                                                                                  
POSITION STATEMENT:  Testified during discussion on SB 198.                                                                   
                                                                                                                                
GENEVIEVE MINA                                                                                                                  
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified during discussion of SB 198.                                                                   
                                                                                                                                
BESSE ODOM                                                                                                                      
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified during discussion of SB 198.                                                                   
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:04:43 PM                                                                                                                    
                                                                                                                                
CHAIR IVY SPOHNHOLZ  called the House Health  and Social Services                                                             
Standing   Committee    meeting   to    order   at    3:04   p.m.                                                               
Representatives  Spohnholz,   Tarr,  Sullivan-Leonard,  Johnston,                                                               
Eastman, Zulkosky, and Kito were present at the call to order.                                                                  
                                                                                                                                
           SB 198-UAA LONG-ACTING CONTRACEPTION STUDY                                                                       
                                                                                                                                
3:05:17 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced  that the only order  of business would                                                               
be  SENATE BILL  NO. 198,  "An  Act relating  to a  study of  the                                                               
effectiveness  and  cost   of  providing  long-acting  reversible                                                               
contraception to women with substance abuse disorders."                                                                         
                                                                                                                                
3:05:42 PM                                                                                                                    
                                                                                                                                
HEATHER  CARPENTER,  Staff,  Senator  Pete  Kelly,  Alaska  State                                                               
Legislature, shared some background on  how Senator Kelly "got to                                                               
this point  of introducing" the  proposed bill.  She  stated that                                                               
the  proposed bill  was part  of an  ongoing effort  to eradicate                                                               
fetal alcohol spectrum  disorder (FASD).  She  paraphrased from a                                                               
white paper  submitted by the Governor's  Council on Disabilities                                                               
and Special Education [Included  in members' packets], which read                                                               
as follows:                                                                                                                     
                                                                                                                                
     Fetal alcohol  spectrum disorders  (FASDs) are  a range                                                                    
     of  developmental  disabilities   caused  by  consuming                                                                    
     alcohol during  pregnancy. The most well-known  type of                                                                    
     FASD is  fetal alcohol  syndrome (FAS). Alaska  has the                                                                    
     highest  reported  prevalence  of  FAS  in  the  United                                                                    
     States.  A  newly published study found  that FASDs may                                                                    
     be  as  common as  autism,  affecting  up  to 1  in  20                                                                    
     children.                                                                                                                  
                                                                                                                                
MS. CARPENTER  added that the  life-long effects of FAS  and FASD                                                               
could  be  physical,  mental,   learning,  or  behavioral  health                                                               
disabilities.  She explained that  pre-natal alcohol exposure was                                                               
dose related, how  much alcohol was in the blood  stream and when                                                               
and  for  how  long  during  the  pregnancy.    She  stated  that                                                               
dependent on when the exposure happened during pregnancy, there                                                                 
were different impacts on the individual.  She further                                                                          
paraphrased from the white paper, which read:                                                                                   
                                                                                                                                
     Neonatal abstinence syndrome (NAS)  is caused by taking                                                                    
     opioids during pregnancy; after  birth, babies with NAS                                                                    
     may  go through  drug withdrawal.  Over 69%  of mothers                                                                    
     who  had  a  baby  that  was  diagnosed  with  NAS  had                                                                    
     previously given birth to other children.                                                                                  
                                                                                                                                
     Infants   exposed  to   opioids   and  alcohol   during                                                                    
     pregnancy have  an increased  risk for  pre-term birth,                                                                    
     life-long disabilities,  and neurodevelopmental delays,                                                                    
     with significant emotional,  social, and economic costs                                                                    
     for individuals, families, and the state.                                                                                  
                                                                                                                                
     FASDs and  NAS are  preventable when women  have access                                                                    
     to  the resources,  support, information,  and care  or                                                                    
     treatment they need for their children or themselves.                                                                      
                                                                                                                                
3:08:30 PM                                                                                                                    
                                                                                                                                
MS. CARPENTER  reported that Senator  Kelly had  first introduced                                                               
legislation   addressing   FASD   in  2014,   Senate   Concurrent                                                               
Resolution 13.  She highlighted  certain whereas clauses included                                                               
in the resolution:                                                                                                              
                                                                                                                                
     Whereas,  fetal alcohol  spectrum disorder  permanently                                                                    
     alters a child's cognitive abilities;                                                                                      
                                                                                                                                
     Whereas,  fetal  alcohol  spectrum  disorder  has  been                                                                    
     identified  as  a  pervasive   and  chronic  driver  of                                                                    
     numerous social challenges throughout the state;                                                                           
                                                                                                                                
     Whereas,  the  occurrence  of  fetal  alcohol  spectrum                                                                    
     disorder is preventable;                                                                                                   
                                                                                                                                
     Whereas, Alaska  has the highest  documented prevalence                                                                    
     of  fetal  alcohol  spectrum disorders  in  the  United                                                                    
     States;                                                                                                                    
                                                                                                                                
     Whereas,  in 2012,  the legislature  passed legislation                                                                    
     making   the  existence   of  fetal   alcohol  spectrum                                                                    
     disorder a mitigating factor for criminal sentencing;                                                                      
                                                                                                                                
      Whereas, misconceptions continue to exist regarding                                                                       
        the causal factors and lifelong effects of fetal                                                                        
     alcohol spectrum disorder;                                                                                                 
                                                                                                                                
3:09:48 PM                                                                                                                    
                                                                                                                                
MS.  CARPENTER  added  that  a  further  resolve  from  this                                                                    
resolution was  that the Alaska State  Legislature supported                                                                    
programs  which would  minimize  the risk  of fetal  alcohol                                                                    
exposure.  She reported that  there had been several efforts                                                                    
to  affect  the  rate  of  FASD  in  Alaska,  which  finally                                                                    
intersected  with   the  four-part  FASD   prevention  model                                                                    
offered  by  Dr. Nancy  Poole,  which  included:   universal                                                                    
messaging strategies  promoting FASD  prevention; increasing                                                                    
access to pregnancy tests; increasing  access to long acting                                                                    
reversible  contraception (LARC);  and increasing  access to                                                                    
substance  abuse  treatment  and   support  services.    She                                                                    
recapped that  the proposed bill would  allow the University                                                                    
of  Alaska  Center  for Alcohol  and  Addiction  Studies  to                                                                    
"evaluate  the feasibility  and  effectiveness of  providing                                                                    
long acting  reversible contraception  to women  involved in                                                                    
services  such  as  Alaska Regional's  neo-natal  abstinence                                                                    
evaluation support  treatment (NEST)  program."   She stated                                                                    
that  the  population  of  women   served  by  this  program                                                                    
represented one  of the  highest risk  groups in  Alaska for                                                                    
unintended   pregnancy  and   pre-natal  drug   and  alcohol                                                                    
exposure.    She  said  that  the study  would  be  done  in                                                                    
collaboration with  hospitals and  health care  providers in                                                                    
Alaska who treat women with  substance abuse disorders.  She                                                                    
pointed out  that the incidence  of children born  with neo-                                                                    
natal abstinence  syndrome (NAS) in Alaska  had increased by                                                                    
more than 500  percent from 2004 - 2015, due  in part to the                                                                    
current opioid  crisis.  Alaska  had more than  120 children                                                                    
diagnosed  with FASD  each year,  although, she  opined, the                                                                    
true rate could be  significantly higher according to recent                                                                    
national prevalence  studies.  She said  that 2,660 children                                                                    
had  been diagnosed  with FASD  in Alaska  since 2001.   She                                                                    
reported that almost 50 percent  of infants with NAS treated                                                                    
at   the  Alaska   Regional  Hospital   NEST  program   were                                                                    
immediately  placed   into  the   care  of  the   Office  of                                                                    
Children's   Services  (OCS),   which,   she  reminded   the                                                                    
committee,  was  the state  law  for  any infant  with  drug                                                                    
exposure.                                                                                                                       
                                                                                                                                
3:13:07 PM                                                                                                                    
                                                                                                                                
MS. CARPENTER, in response to  Representative Johnston, said that                                                               
this included both FASD and FAS.                                                                                                
                                                                                                                                
REPRESENTATIVE JOHNSTON shared that an  issue for both was a lack                                                               
of diagnosis  in children.  She  asked if these numbers  were for                                                               
children that had  "come through some system where  there is some                                                               
diagnosis."                                                                                                                     
                                                                                                                                
MS. CARPENTER admitted that this was  a part of the challenge, as                                                               
it  was  necessary to  prove  there  was some  pre-natal  alcohol                                                               
exposure, in order to get  diagnosis, adding that diagnosis was a                                                               
long and lengthy  process.  She directed attention  to letters of                                                               
support  [Included in  members'  packets] from  Karen Perdue  and                                                               
Niesje Steinkruger.  She shared  some of her personal experiences                                                               
working with young people who suffered from FASD.                                                                               
                                                                                                                                
3:17:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD asked  about  case studies  from                                                               
the Institute  of Circumpolar Health  with regard to FAS  and its                                                               
prevention and whether this had already been studied.                                                                           
                                                                                                                                
MS. CARPENTER  replied that this  study regarding access  and the                                                               
barriers  had not  specifically been  studied.   She shared  that                                                               
there was a lot of interest  from other states for the results of                                                               
this study.                                                                                                                     
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  asked what information  had been                                                               
pulled from  these other FAS  studies.  She  asked if it  was the                                                               
desire of the sponsor to  work solely through the Alaska Regional                                                               
Hospital  for information  from its  patients or  would there  be                                                               
research for information from rural areas.                                                                                      
                                                                                                                                
MS. CARPENTER  replied that  the proposed  bill was  very careful                                                               
not  to name  one  specific  hospital in  the  legislation.   She                                                               
acknowledged  that   Alaska  Regional  Hospital  was   the  first                                                               
hospital ready  to partner because  they already had  the ongoing                                                               
NEST  program and  an ongoing  relationship with  the university.                                                               
She expressed hope  that other hospitals in Alaska  would also be                                                               
interested in participation.                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  asked about  the results  of the                                                               
studies from the pregnancy tests from the various bars.                                                                         
                                                                                                                                
MS. CARPENTER offered  to provide those results  to the committee                                                               
members.                                                                                                                        
                                                                                                                                
3:21:47 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE ZULKOSKY referenced a  program by the [Centers for                                                               
Disease  Control  and  Prevention]  CDC for  choices  to  prevent                                                               
alcohol exposed pregnancies  which used motivational interviewing                                                               
to increase a woman's motivation  and commitment to change.  This                                                               
included  two  to   four  counseling  sessions,  as   well  as  a                                                               
contraceptive  counseling  session.    She added  that  this  was                                                               
implemented  in  various   settings  including  community  health                                                               
centers and family planning clinics.   She pointed out that there                                                               
were  also facilitator  guides, client  workbooks, and  counselor                                                               
manuals all developed  by the CDC.  She asked  if the development                                                               
of the  proposed study  had gleaned any  best practices  from the                                                               
CDC.                                                                                                                            
                                                                                                                                
MS. CARPENTER replied  that the University [of  Alaska] had built                                                               
on information from that choices study.                                                                                         
                                                                                                                                
REPRESENTATIVE ZULKOSKY reported that  the CDC research was being                                                               
implemented  in  Baltimore,  Denver,   New  York  City,  and  Los                                                               
Angeles.  She pointed to the  proposed fiscal note, and asked why                                                               
the   proposed  legislation   was  not   duplicative,  hence   an                                                               
unnecessary  expense, with  this already  implemented information                                                               
and resources.                                                                                                                  
                                                                                                                                
MS. CARPENTER referenced the personnel  costs in the fiscal note,                                                               
and stated  that it was  not covering the entire  person's salary                                                               
as that person would continue to work on other projects.                                                                        
                                                                                                                                
3:24:40 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   ZULKOSKY  expressed   her  understanding   that,                                                               
although it did not cover the  full staff expense, there was only                                                               
$200,000  of the  $500,000 appropriation  left for  statistically                                                               
relevant  analysis, whether  that  be health  care, planning,  or                                                               
outreach.                                                                                                                       
                                                                                                                                
MS.  CARPENTER explained  that,  as this  budget  was offered  in                                                               
conjunction with the university, she  did not have the answers to                                                               
those questions.  She opined  that the university would implement                                                               
other research.                                                                                                                 
                                                                                                                                
3:25:47 PM                                                                                                                    
                                                                                                                                
CHAIR  SPOHNHOLZ suggested  that a  follow up  response from  the                                                               
university would be useful.                                                                                                     
                                                                                                                                
3:26:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   KITO  asked   about  the   fiscal  note,   which                                                               
identified personal  services for  more than  half the  grant and                                                               
noted  that nothing  had been  allocated for  travel.   He opined                                                               
that  the vast  majority  of  the money  would  go to  university                                                               
employees  instead of  care for  the subject  of the  study.   He                                                               
expressed his  concern for adequate  medical support,  as nothing                                                               
was  mentioned in  the fiscal  note  for medical  oversight.   He                                                               
added  that the  fiscal note  description  was quite  vague.   He                                                               
asked  whether there  was enough  money in  the study  to "do  it                                                               
right"  because if  only so  much of  the money  is going  to the                                                               
actual  study, a  lot of  the money  is going  to personnel.   He                                                               
mentioned that Phase  2 of the program was  to implement referral                                                               
protocols    and   assemble    data   collection    and   network                                                               
collaboration, and  that Phase 3  was to implement  data analysis                                                               
and reporting,  data analysis strategy development  outcomes, and                                                               
reporting  strategy recommendations.   He  emphasized that  there                                                               
was  nothing mentioned  for medical  support  to the  individuals                                                               
receiving  the  intervention  or  for  any  follow  up  to  those                                                               
individuals  to  ensure  medical   support  throughout  the  time                                                               
impacted by this  intervention.  He asked for  assurance that the                                                               
participants would receive adequate medical care.                                                                               
                                                                                                                                
MS. CARPENTER replied  that she would contact  the University and                                                               
request that the fiscal note  provide more detail.  She explained                                                               
that part  of the  money would  go for a  case manager  to ensure                                                               
that the  participants had follow  up care  and that part  of the                                                               
money   would  pay   for  the   actual  contraception   to  those                                                               
participants who did not have medical insurance.                                                                                
                                                                                                                                
3:29:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EASTMAN asked  for  the total  amount of  funding                                                               
from all the various sources for this project.                                                                                  
                                                                                                                                
MS.  CARPENTER replied  that the  total funding  from the  fiscal                                                               
note would  be drawn  from the general  fund, and  that currently                                                               
there were not any matching funds.                                                                                              
                                                                                                                                
3:30:03 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ  offered her  belief that there  had also  been a                                                               
federal funding request.                                                                                                        
                                                                                                                                
3:30:12 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN asked  about the impact to  the project if                                                               
there was not any additional funding.                                                                                           
                                                                                                                                
MS. CARPENTER reported that the  entire University budget for the                                                               
three-year project was $500,000.   She opined that the University                                                               
would continue to work to  get other funding, although they could                                                               
move forward given this amount.                                                                                                 
                                                                                                                                
REPRESENTATIVE  EASTMAN  asked how  the  federal  funds would  be                                                               
used.                                                                                                                           
                                                                                                                                
MS.  CARPENTER said  that she  did  not know  without seeing  the                                                               
application.                                                                                                                    
                                                                                                                                
3:31:30 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ opened invited testimony on SB 198.                                                                             
                                                                                                                                
3:32:02 PM                                                                                                                    
                                                                                                                                
WILLIAM TRAWICK,  Advanced Nurse  Practitioner, said that  he was                                                               
the author of  the NEST program at Alaska Regional  Hospital.  In                                                               
response to Chair  Spohnholz, he explained that  the NEST program                                                               
was  designed to  care for  substance exposed  infants, both  the                                                               
immediate  medical care  and  the  detoxification and  controlled                                                               
medical withdrawal.   He said that  it also involved the  care of                                                               
the families of  the infants, with an effort to  maintain them or                                                               
enroll them  in substance  recovery programs.   He  reported that                                                               
this was a diverse population  of Alaska residents, and that this                                                               
population was, on average, 99  percent state Medicaid enrollees.                                                               
He reported  that this diverse  population included  street level                                                               
substance users,  those in medication assisted  drug therapy, and                                                               
persons who  suffered from chronic pain  syndromes which required                                                               
opiate treatment.  He said this  was a diverse population of both                                                               
licit and illicit substance using persons.                                                                                      
                                                                                                                                
MR. TRAWICK,  in response to  Representative Zulkosky,  said that                                                               
the population  was very  diverse, and it  was difficult  to draw                                                               
any specifics  from this population.   He added  that, generally,                                                               
the  patients  were  Medicaid   recipients,  were  using  illicit                                                               
medications as  well as legal  drug medication  assisted therapy.                                                               
He  stated  that  frequently  there   were  mothers  enrolled  in                                                               
methadone  programs,  and,  after  delivery, as  the  baby  would                                                               
become part of  their program, the family would  also become part                                                               
of the program.   He explained that a  defining characteristic of                                                               
the  NEST program  was  that  it was  a  family centered,  family                                                               
intensive program.                                                                                                              
                                                                                                                                
3:36:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE ZULKOSKY asked if there  were cases which had been                                                               
referred  statewide in  the program,  and if  so, from  where had                                                               
those referrals originated.                                                                                                     
                                                                                                                                
MR. TRAWICK replied  that the majority of the  patients were from                                                               
the  Anchorage  area, although  there  were  also referrals  from                                                               
outside  areas.    He  pointed  out that  it  was  expensive  and                                                               
difficult  to medically  air  transport a  baby  from an  outside                                                               
community  to  Anchorage.    He reported  that  infants  who  did                                                               
require air transport to Anchorage  became patients at Providence                                                               
Alaska Medical Center even though  there were not the services of                                                               
the NEST program.                                                                                                               
                                                                                                                                
3:38:59 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KITO  asked  about  the resources  for  the  NEST                                                               
program to medically oversee the  actions related to the proposed                                                               
study in regard to the mothers of the children.                                                                                 
                                                                                                                                
MR.  TRAWICK reiterated  that the  primary characteristic  of the                                                               
NEST program was  for a family focus and to  develop a culture of                                                               
respect with an  absence of shame.  He declared  that the program                                                               
goal  was  to  treat  babies suffering  from  withdrawal  and  to                                                               
maintain infants in the care  of their biological family whenever                                                               
possible.   He emphasized  that this  was an  extremely difficult                                                               
environment to maintain.  He  explained that babies who could not                                                               
be  managed  effectively  with  common  sense  measures  such  as                                                               
holding and  soothing to decrease stimulation,  were moved inside                                                               
the NEST  unit for medically assisted  therapies, often including                                                               
minute  doses of  morphine, which  required very  high levels  of                                                               
nursing care.  He  noted that this was often a  ratio of one baby                                                               
with one  nurse, a fundamental  requirement for  babies suffering                                                               
from  opiate  withdrawal.    He shared  that  when  possible  the                                                               
biological family was included, under  guidance, in this care for                                                               
the  babies, even  though this  was  sometimes too  much for  the                                                               
families.                                                                                                                       
                                                                                                                                
3:42:59 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KITO  asked, as  the  proposed  study included  a                                                               
medical  intervention for  the mothers,  what resources  the NEST                                                               
program had  to provide medical  oversight and treatment  for the                                                               
mothers  receiving  the  proposed contraception  intervention  to                                                               
ensure they were not adversely affected health wise.                                                                            
                                                                                                                                
MR.  TRAWICK  explained that  an  important  aspect of  the  NEST                                                               
program was  that every mother entering  Alaska Regional Hospital                                                               
for  delivery underwent  a screening  process, called  the 4  P's                                                               
Plus,  which was  a widely  validated tool  to assess  a mother's                                                               
risk of  alcohol and substance use  and exposure.  He  added that                                                               
this program  was now used  in hospitals throughout Alaska  as it                                                               
allowed the hospital  to know when a woman was  at risk for these                                                               
exposures.    He pointed  out  that  the  NEST program  was  well                                                               
positioned to  determine mothers  who may  be candidates  for the                                                               
LARC, emphasizing  that the program  was voluntary.   He declared                                                               
that it was vital to maintain this culture of respect.                                                                          
                                                                                                                                
3:46:25 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KITO reiterated  that, as many of  these women did                                                               
not have  regular health  care, they  had no  access to  a health                                                               
care provider.   As the proposed legislation  was recommending an                                                               
invasive  medical procedure,  he asked  for assurance  that there                                                               
would be needed medical oversight for the women receiving LARCs.                                                                
                                                                                                                                
MR. TRAWICK  expressed his  agreement that  the vast  majority of                                                               
the women  in the program  did not have  a medical provider.   He                                                               
explained that  part of  the NEST  program was  to get  the women                                                               
into  a  "conventional medical  relationship."    He stated  that                                                               
women  were not  discharged  from the  program without  follow-up                                                               
providers,  even   though  it  was   a  small  pool   of  medical                                                               
professionals  who showed  an interest  in taking  care of  these                                                               
mothers.                                                                                                                        
                                                                                                                                
REPRESENTATIVE KITO  asked if there  were medical doctors  in the                                                               
NEST program that provided care for the mothers.                                                                                
                                                                                                                                
MR. TRAWICK replied, "Not in the NEST program."                                                                                 
                                                                                                                                
3:48:40 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EASTMAN  asked  if  the  proposed  program  would                                                               
meaningfully contribute  to the culture  of respect, or  was some                                                               
"fine tuning" still necessary.                                                                                                  
                                                                                                                                
MR.  TRAWICK  expressed his  agreement  that  some "fine  tuning"                                                               
still be necessary  as it was a very sensitive  issue.  He stated                                                               
that it  was a  "horrible thought"  for any  family to  think the                                                               
mother was going  to be sterilized.  He emphasized  that the NEST                                                               
program was very sensitive to this issue.                                                                                       
                                                                                                                                
3:49:52 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ  asked how parents were  connected with addiction                                                               
treatment.                                                                                                                      
                                                                                                                                
MR. TRAWICK explained  that there was a  licensed clinical social                                                               
worker who  maintained some very  close relationships  within the                                                               
provider network.                                                                                                               
                                                                                                                                
3:50:49 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ  asked if there  were barriers to  getting people                                                               
into  treatment  and if  there  was  enough access  to  addiction                                                               
treatment in Alaska.                                                                                                            
                                                                                                                                
MR. TRAWICK expressed  his agreement, stating that  there was "no                                                               
end  to the  amount of  barriers," although  he mused  that there                                                               
were some promising developments.   He reported that the planning                                                               
was  well underway  for the  development of  a behavioral  health                                                               
program  at   Alaska  Regional  Hospital,  which   would  include                                                               
detoxification  beds as  well as  substance treatment.   He  said                                                               
that families had  so many reasons to avoid  these decisions, and                                                               
that the  NEST focus  was to work  around these  obstructions and                                                               
visualized threats.   He  added that a  new peer  support program                                                               
had  just  been  instituted  which  he opined  could  be  a  very                                                               
powerful tool to encourage mothers to proceed in treatment.                                                                     
                                                                                                                                
3:52:38 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ  asked if the NEST  program had been able  to get                                                               
everyone who was ready into treatment.                                                                                          
                                                                                                                                
MR. TRAWICK  said that  the biggest issue  was almost  always for                                                               
the availability of beds.  He  reported that very few programs in                                                               
Alaska  would allow  a mother  to  be enrolled  in an  in-patient                                                               
program and maintain  custody of their child.  He  noted that the                                                               
methadone  program,  although  perfectly  adequate,  was  not  an                                                               
inpatient program.                                                                                                              
                                                                                                                                
3:56:01 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ  offered her understanding  that the  program was                                                               
primarily  designed  for  families  with  infants  born  with  an                                                               
addiction  to  opiates,  whereas  the  proposed  legislation  was                                                               
focused  on  FASD.    She  asked  how  they  would  identify  the                                                               
patients, and  what would be  done differently  to operationalize                                                               
this.                                                                                                                           
                                                                                                                                
MR.  TRAWICK  replied  that  the   assessment  program  was  well                                                               
validated for alcohol  usage issues.  He opined  that the efforts                                                               
for  screening,  including  short  interventions  and  access  to                                                               
further therapies, would  be the most valuable  tool, adding that                                                               
all  mothers   delivering  at   Alaska  Regional   Hospital  were                                                               
screened.  He  expressed his agreement with  Chair Spohnholz that                                                               
this would determine the referrals to the NEST program.                                                                         
                                                                                                                                
3:56:36 PM                                                                                                                    
                                                                                                                                
MARILYN PIERCE-BULGER, Owner, FASDx  Services, added that she was                                                               
also representing the non-profit  organization, Alaska Center for                                                               
FASD.  She reported that FASD  was more common and prevalent than                                                               
previously  thought,  impacting  more  than  1  in  20  children,                                                               
whereas autism affected  1 in 68 children and ADHD  affected 1 in                                                               
110  children.    She  pointed   out  that  there  was  not  good                                                               
prevalence  data for  Alaska, and  that individuals  who had  not                                                               
been diagnosed  were at increased  risk for  self-medication with                                                               
alcohol and  substances.  She  reported that data  indicated that                                                               
80 percent  of women  using substances  were also  using alcohol.                                                               
She  noted that  individuals diagnosed  with FASD  were impacting                                                               
the  health, education,  social  services,  and criminal  justice                                                               
systems,  and, even  more important,  their own  daily lives  and                                                               
their life  trajectories.   She emphasized that  this was  a life                                                               
long disability  which could contribute  to chronic  pain, immune                                                               
response  conditions,  anxiety, and  depression.    She shared  a                                                               
report  from  CDC which  indicated  that  the women  drinking  in                                                               
pregnancy  in 2018  were white,  working, college  educated women                                                               
who believed that  their low to moderate alcohol  doses would not                                                               
have any  impact on  their children.   She reported  that alcohol                                                               
had  more  long-term  impact  than   many  of  the  other  abused                                                               
substances.  She noted that although  many of the women were able                                                               
to  stop   the  alcohol  use,  their   pregnancies  were  already                                                               
impacted.   She offered  her belief  that women  using substances                                                               
wanted something  different for  themselves and their  babies, so                                                               
that helping  them explore  the options  with LARC  and substance                                                               
abuse treatment offered  them more choice and  control over their                                                               
lives.  She stated that the  proposed bill was a strategy to help                                                               
women help themselves.                                                                                                          
                                                                                                                                
4:01:45 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  ZULKOSKY  asked  about   the  reduction  for  the                                                               
prevalence of  FASD and neo-natal exposure  to illicit substances                                                               
and the need to provide  greater support and wrap around services                                                               
for Alaskans seeking substance  abuse treatment and comprehensive                                                               
contraceptive options for women.   She expressed her concern with                                                               
the proposed bill as it would  seek to treat one part of Alaska's                                                               
population of women differently  than others and would stigmatize                                                               
one group  of Alaska women.   She noted that the  implication was                                                               
that  women with  substance abuse  disorders should  be prevented                                                               
from  having   children.    She   expressed  her   difficulty  in                                                               
reconciling   how  providing   effective  birth   control  to   a                                                               
population of women  who may be having children who  were seen as                                                               
a cost challenge  to the State of  Alaska.  She deemed  this as a                                                               
fine  line   into  dangerous  territory.     She   expressed  her                                                               
understanding for protecting children  but asked how the proposed                                                               
bill  would  protect women  who  were  struggling and  would  not                                                               
malign them.                                                                                                                    
                                                                                                                                
MS.  PIERCE-BULGER  offered  her belief  that  the  professionals                                                               
working with  these issues were  "incredibly sensitive to  all of                                                               
what  you just  mentioned."   She shared  that, in  her years  of                                                               
experience  working with  women living  on the  edge, that  being                                                               
safe,  having a  roof overhead,  and food  on the  table was  the                                                               
priority.    She noted  that  these  women  were also  trying  to                                                               
"achieve some  level of control  over their lives" and  wanted to                                                               
have effective  birth control,  although some  of the  women were                                                               
not able to access it for a  variety of reasons.  She opined that                                                               
the  proposed bill  could  make  effective contraceptive  choices                                                               
more easily available to vulnerable  women in the community.  She                                                               
mused that, as stigma got in  the way of all conversations around                                                               
substance use and  FASD, it was necessary  to normalizing certain                                                               
responses in the health care system.                                                                                            
                                                                                                                                
4:06:58 PM                                                                                                                    
                                                                                                                                
CHAIR  SPOHNHOLZ stated  that  there was  not  a great  community                                                               
awareness  for the  prevalence of  FASD  and what  was needed  to                                                               
provide support.  She shared a personal anecdote.                                                                               
                                                                                                                                
4:08:27 PM                                                                                                                    
                                                                                                                                
ROBERT  BOECKMANN,  Ph.D.,   Chair,  Institutional  Review  Board                                                               
(IRB),  University  of  Alaska  Anchorage,  said  that  this  was                                                               
sometimes called the ethics committee.   He explained the role of                                                               
the  IRB  to  ensure  the respectful  and  ethical  treatment  of                                                               
research  participants.    He   corrected  earlier  testimony  by                                                               
Senator Kelly which stated that  the legislature had the capacity                                                               
to authorize  the conduct of the  LARC studies at UAA  Center for                                                               
Addiction Studies,  declaring that  to be  "categorically false."                                                               
He emphasized that  the authorization to conduct  the studies had                                                               
to go  through the IRB and  that ultimately, it was  his decision                                                               
to authorize  the conduct  of a  study involving  human subjects.                                                               
He acknowledged that the legislature  could authorize the funding                                                               
but not  the conduct of the  study.  He offered  a brief overview                                                               
of the IRB,  its membership, a review of  the research protocols,                                                               
and what the  IRB was empowered to do with  regard to reaction to                                                               
those research  protocols.   He stated  that research  with human                                                               
subjects  had  a  fairly  long,  complicated,  and  controversial                                                               
history.  He  added that concerns about research  ethics were not                                                               
an integral  part of research  until the Nuremberg  Trials, which                                                               
exposed some horrible atrocities.                                                                                               
                                                                                                                                
4:11:48 PM                                                                                                                    
                                                                                                                                
DR. BOECKMANN  mentioned the Tuskegee Institute  syphilis studies                                                               
from 1932 - 1972 and those  injustices imposed by the U.S. Public                                                               
Health  Service  led   to  the  formal  adoption   of  rules  and                                                               
regulations  that  now guided  and  ensured  respect to  research                                                               
participants.   He  reported  that  the conduct  of  the IRB  was                                                               
guided by  federal rules.   He explained  that the minimum  was 5                                                               
members  while UAA  had 11  members, and  this had  to include  a                                                               
member with  scientific expertise,  a member  with non-scientific                                                               
expertise, and a  member not affiliated with  the university, the                                                               
community representative  to bring  the community  values, needs,                                                               
and concerns  to any discussions.   He added that the  IRB, under                                                               
certain  circumstances,  could  be directed  to  have  additional                                                               
types  of  representative,  specifically  from any  group  to  be                                                               
tested.   He  pointed  out that  with any  review  of a  research                                                               
protocol  involving medical  intervention,  it  was necessary  to                                                               
have a medical doctor included in  the discussion.  He noted that                                                               
the current membership of the UAA  IRB was listed on its website,                                                               
with  the  regular  open  public  meetings  also  posted  on  the                                                               
website.   He  explained that  prior to  the meetings,  the board                                                               
members reviewed  the protocols  and prepared notes  and comments                                                               
for deliberation  on any  concerns.  He  emphasized that  the IRB                                                               
had the  power to  disapprove, modify, or  stop any  studies that                                                               
were inconsistent with the federal  guidelines.  He stressed that                                                               
no human  research activity  was allowed to  be conducted  at UAA                                                               
unless it  was rigorously  reviewed by the  IRB.   He highlighted                                                               
the  seven criteria  that  IRB  used for  review  of a  protocol:                                                               
assess  risks and  ensure they  are  minimized for  little or  no                                                               
danger to participants;  assess that any risks  are beneficial to                                                               
the  study results;  selection of  the  research participants  is                                                               
equitable  across a  wide segment  of  society; informed  consent                                                               
documented   from  each   participant;  adequate   provision  for                                                               
monitoring  the data  security; and,  privacy  of the  data.   He                                                               
added that  if and  when approval  of study  was granted,  it was                                                               
necessary for  a progress  report, which  for a  high-risk study,                                                               
was required  in 3 months,  or at  any point necessary  to ensure                                                               
the safety  and well being of  the participants.  He  stated that                                                               
any  modification by  the researcher  of the  protocol had  to be                                                               
presented to the IRB for review.                                                                                                
                                                                                                                                
4:22:30 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KITO   asked  how  many  requests   for  research                                                               
involving medical intervention did the IRB review annually.                                                                     
                                                                                                                                
DR. BOECKMANN replied that they  did not see a medically invasive                                                               
intervention similar to the LARC  studies very often, perhaps one                                                               
or two per year.                                                                                                                
                                                                                                                                
REPRESENTATIVE KITO expressed his concern  for follow up care and                                                               
asked about individuals  who may leave the study but  then have a                                                               
medical problem post-study.  He  asked if the IRB would recommend                                                               
that  the intervention  be terminated  before  completion of  the                                                               
study  or  recommend a  protocol  for  follow  up care  to  every                                                               
individual  who  had received  the  intervention  and could  have                                                               
support for removal post-study.   He asked for assurance that the                                                               
individuals would  have support  while in the  study, as  well as                                                               
post-study.                                                                                                                     
                                                                                                                                
DR.  BOECKMANN  said  that  the  IRB  would  require  a  specific                                                               
procedure  or  plan of  follow  up  care  and funding  for  those                                                               
individuals having the LARC intervention.                                                                                       
                                                                                                                                
4:27:06 PM                                                                                                                    
                                                                                                                                
DR.  BOECKMANN, in  response to  Representative  Tarr, said  that                                                               
informed  consent from  each  individual in  the  study would  be                                                               
documented.                                                                                                                     
                                                                                                                                
REPRESENTATIVE  TARR  expressed  her   concern  that  the  actual                                                               
process would include coercion to  participate, as the individual                                                               
would  be in  a very  vulnerable state  during post-delivery  and                                                               
withdrawal.   She  asked  how  the plan  could  be "whole  person                                                               
centered"  and  suggested  that  the  individual  could  need  an                                                               
advocate.                                                                                                                       
                                                                                                                                
4:31:26 PM                                                                                                                    
                                                                                                                                
DR. BOECKMANN  segued into the  informed consent  requirement and                                                               
process.   He stated  that the  IRB reviewed  specific procedures                                                               
and plans,  and expressed his  understanding that  currently this                                                               
plan did  not yet exist.   He stated that the  federal government                                                               
required  an informed  consent process  and he  listed the  seven                                                               
requirements  for   informed  consent:     the  study   has  been                                                               
adequately described;  a description  of an foreseeable  risks or                                                               
discomforts that  may be encountered;  describe the  benefits the                                                               
subject  may receive  directly or  the benefits  extended through                                                               
study to  society; a statement  that participation  was voluntary                                                               
and that  refusal to participate or  discontinue participation at                                                               
any time  would involve no  penalty or  loss of benefit  to which                                                               
the  participant  was  otherwise   entitled;  disclosure  of  any                                                               
alternative  procedures  or  courses  of treatment  that  may  be                                                               
available; describe  the extent  to which any  confidentiality of                                                               
record  or identifying  information would  be maintained,  and if                                                               
there were any  possibility for a breach of  confidentiality;  an                                                               
explanation for  more than minimal  risks from the  research, and                                                               
any   medical  treatment   available  if   injury  occurs;   and,                                                               
information  for  who  to  contact   if  there  are  concerns  or                                                               
questions  about  the research  participation.    He stated  that                                                               
there are  some special requirements for  vulnerable populations,                                                               
including   children  and   adults   with  diminished   capacity,                                                               
regarding consent.                                                                                                              
                                                                                                                                
4:38:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR  reported  that,  as  her  constituency  had                                                               
varying  levels of  trust for  those in  positions of  authority,                                                               
there  was a  concern that  individuals would  feel they  did not                                                               
have the ability  to make their own choice.   She stated her need                                                               
to feel there  were enough safeguards in place.   She pointed out                                                               
that reproductive  health care and  the use of birth  control was                                                               
not always viewed as positive.                                                                                                  
                                                                                                                                
DR.  BOECKMANN  declared that  the  issue  of coercion  was  very                                                               
important to  the IRB.   He offered  an example of  proposals for                                                               
research  participants from  prisons.   He pointed  out that  the                                                               
issues of  choice, coercion, and  the power  differential between                                                               
the researcher  and the participant  was closely examined  by the                                                               
IRB as it differed by population group.                                                                                         
                                                                                                                                
4:42:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KITO expressed  his  concern  that mothers  would                                                               
have  an expectation  that participation  in the  study with  the                                                               
LARC, or  other contraceptive, might  have an impact  for whether                                                               
they would get their child back from OCS custody.                                                                               
                                                                                                                                
DR.  BOECKMANN  said that  the  IRB  was  very sensitive  to  the                                                               
context  of the  research, recognizing  that different  groups of                                                               
people  had  different  needs, concerns,  and  perceptions.    He                                                               
acknowledged  that a  woman may  believe that  she would  gain an                                                               
advantage, possibly  getting her baby back,  if she participated.                                                               
He suggested that this would be  a conversation by the IRB, which                                                               
could require  language in the  consent form that  would indicate                                                               
that  hospital treatment  for  the  baby would  not  differ as  a                                                               
function of participation in the study.                                                                                         
                                                                                                                                
REPRESENTATIVE KITO said that there  were nuances in the proposed                                                               
bill that could be very complicating.                                                                                           
                                                                                                                                
4:45:22 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR shared  a  letter to  the  House Health  and                                                               
Social Services  Standing Committee  that indicated that  the IRB                                                               
could make mistakes, even though  unintentional.  She listed some                                                               
of the concerns for follow up  care and removal of the LARC which                                                               
would be addressed  by proposed amendments.  She  asked about the                                                               
IRB representation from the people participating in the study.                                                                  
                                                                                                                                
DR. BOECKMANN  acknowledged that  IRBs had  made mistakes  in the                                                               
past, even as he  did his best to ensure that  there would not be                                                               
any mistakes.   He  directed attention to  a letter  [Included in                                                               
members' packets]  from Serene  Rose O'Hara-Jolley,  pointing out                                                               
that this letter was not clear  as to which IRB or which protocol                                                               
she was referencing, and that he  did not recall working with her                                                               
at the UAA IRB.  He relayed  that the UAA IRB processed about 600                                                               
protocols  each  year.    He  spoke  about  the  requirement  for                                                               
representation  on  the  IRB,  and,  although  there  was  not  a                                                               
requirement  for a  certain ethnic  representation, there  was an                                                               
attempt to have ethnic diversity and a balance of men and women.                                                                
                                                                                                                                
4:51:54 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR   offered  her  belief  that   it  was  very                                                               
important to  have women,  and women  of color,  as part  of this                                                               
representation to introduce some of  their experience.  She asked                                                               
whether there were invitations for  feedback or participation, or                                                               
would the advisory council developing the protocols be diverse.                                                                 
                                                                                                                                
DR. BOECKMANN  said that  part of the  evaluation was  looking at                                                               
the extent  to which  the protocol  was inclusive  and respectful                                                               
for the community  assessed.  He pointed out that  the actual IRB                                                               
membership  included:  a  Hispanic  woman  with  advanced  health                                                               
professional credentials, including  two master's degrees focused                                                               
on  women and  community health,  and a  Doctorate.   He reported                                                               
that he  had been working  with this IRB  for more than  a decade                                                               
and that "they take the community's concern very seriously."                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that SB 198 would be held over.                                                                       
                                                                                                                                
4:54:47 PM                                                                                                                    
                                                                                                                                
JEANNE GERHARDT-CYRUS, Governor's Council,  shared that she was a                                                               
parent of multiple children with  pre-natal exposure [to alcohol]                                                               
and that  she was  Chair of  the prevention  work group  on FASD.                                                               
She  expressed her  agreement for  the  safeguarding of  people's                                                               
rights.    She   declared  support  to  empower   women  to  plan                                                               
pregnancies  when they  were ready  and  to enable  them to  give                                                               
birth to  healthy children  by virtue of  having access  to LARC.                                                               
She  pointed out  that, although  unplanned  pregnancies did  not                                                               
mean  unwanted  pregnancies,  it  could  include  unprepared  for                                                               
establishing   a  healthy   environment  for   the  baby.     She                                                               
acknowledged the high rate of  women with opioid use disorder who                                                               
had unplanned  pregnancies.  She  shared her  personal experience                                                               
of children with FASD, all  of which was 100 percent preventable.                                                               
She declared that  she was not looking to  prevent these children                                                               
from being born,  but just wanted to increase the  odds that they                                                               
would be  born healthy by ensuring  that women had the  access to                                                               
choose LARC.  She encouraged the proposed study.                                                                                
                                                                                                                                
REPRESENTATIVE TARR reiterated that it  is necessary for women to                                                               
be empowered and to have choices.                                                                                               
                                                                                                                                
5:02:51 PM                                                                                                                    
                                                                                                                                
ELLEN  HODGES, M.D.,  advised that  she is  a physician  in rural                                                               
Alaska that primarily serves Alaska  Native residents, and she is                                                               
testifying on  her own behalf.   She expressed  concern regarding                                                               
SB 198,  the testimony regarding  the children affected  by drugs                                                               
and  alcohol,  and  the  women  who  will  be  affected  by  this                                                               
legislation.   Dr. Hodges advised  that within her  practice, she                                                               
takes  care   of  many   women  and   children  and   she  offers                                                               
reproductive health.  This legislation  could return the state to                                                               
the "shameful  days" when forced sterilization  and contraceptive                                                               
coercion  was a  common  occurrence  for vulnerable  populations,                                                               
including the Alaska  Native and American Indian  population.  In                                                               
the 1990s, Norplant  was used, which is  a long-acting reversible                                                               
contraceptive (LARC) implant and has  since been removed from the                                                               
market,  wherein it  was required  of  some women  to obtain  its                                                               
benefits in order to avoid  incarceration.  Clearly, she said, no                                                               
one  wants children  born  who  have been  exposed  to drugs  and                                                               
alcohol  in   utero,  but  medical  professionals   already  have                                                               
available the randomized controlled  trials that established best                                                               
practices in order  to reduce alcohol use in women  who engage in                                                               
risky drinking  behavior.  The  Center for Disease  Control (CDC)                                                               
CHOICES  program  [prevent alcohol-exposed  pregnancies]  details                                                               
such best practices  and, she advised, there are  many other such                                                               
evidence  based  programs that  have  been  validated across  the                                                               
nation  in  many  populations.   Furthermore,  she  advised,  the                                                               
American  Academy  of  Pediatrics already  established  the  best                                                               
treatment  for utero  abstinence  syndrome,  and further  advised                                                               
that there are  many disciplinary teams across the  state able to                                                               
diagnose and  treat fetal alcohol substance  disorder (FASD), and                                                               
follow up with the families.   This money, she pointed out, could                                                               
be better spent on programs such  as the CDC CHOICES program that                                                               
has already been researched and  validated, or spend the money on                                                               
drugs  and alcohol  treatment programs  that  are so  desperately                                                               
needed in the rural areas in Alaska, and in her community.                                                                      
                                                                                                                                
5:05:11 PM                                                                                                                    
                                                                                                                                
DR. HODGES  further expressed concern  about this sort  of design                                                               
and  the  follow up  of  the  women with  long-acting  reversible                                                               
contraceptives  implants  because   this  type  of  contraception                                                               
cannot be removed  by the woman herself, the  removal requires an                                                               
appointment  with a  health care  provider.   These implants  can                                                               
remain in  place for up  to ten years,  and she asked:  "How will                                                               
they be  followed; who pays for  the removal; what if  they leave                                                               
the State of Alaska; who  handles complications - for example, an                                                               
exploratory laparotomy  for a woman with  a migrated intrauterine                                                               
device (IUD)."   She referred to the  evidence that comprehensive                                                               
wrap   around    care   with   motivational    interviewing   and                                                               
comprehensive  contraceptive  counseling reduces  risky  drinking                                                               
behavior, and  stressed that this  legislation does  not describe                                                               
the design  in enough detail.   The testimonies heard  today from                                                               
the (NEST)  program and  the IRB  from UAA  do not  alleviate her                                                               
considerable concerns that these  women will either explicitly or                                                               
implicitly   be  coerced   into   using  long-acting   reversible                                                               
contraception.   Thereby,  returning  the state  to  the days  of                                                               
forced  sterilization when  it was  allowed  and encouraged,  she                                                               
expressed.   Studies  have proven  that access  to birth  control                                                               
counseling and  motivational interviewing reduces  risky drinking                                                               
behavior among  women who  do, and  do not,  have children.   She                                                               
said that  she simply does  not believe this study  is necessary,                                                               
and it puts the  state at risk of going down  in history of using                                                               
those shameful programs  that allow this type of  coercion.  That                                                               
history  is a  dark stain  put upon  the medical  area where  she                                                               
practices, she remarked.                                                                                                        
                                                                                                                                
5:07:07 PM                                                                                                                    
                                                                                                                                
GENEVIEVE MINA  advised that  she is  a UAA  student representing                                                               
herself, and  offered support  for the legislation.   As  a woman                                                               
with a  long-acting reversible  contraceptives (LARC),  she knows                                                               
that her IUD  is over 99 percent effective and  it is far cheaper                                                               
and  convenient than  other forms  of birth  control.   She noted                                                               
that  she  comes  from  a  privileged  background  that  included                                                               
comprehensive sexual  education at  her high school,  and knowing                                                               
under which providers she is  covered under her health insurance.                                                               
Currently,  the conventional  method of  birth control  works for                                                               
her, but it is not working  for women with substance abuse issues                                                               
who  statistically have  higher rates  of unplanned  pregnancies.                                                               
It  is  her belief,  she  said,  that addressing  women's  health                                                               
regarding  substance  abuse disorders  is  far  more complex  and                                                               
nuanced than  simply offering more access  to contraceptive care.                                                               
It is necessary  to rethink what access means,  and she explained                                                               
that  access is  about surpassing  financial, institutional,  and                                                               
social  barriers.   She  pointed to  the  financial barriers  and                                                               
noted that  simply because  the service can  be accessed  free of                                                               
charge does  not necessarily  mean a woman  has the  incentive to                                                               
obtain   that  service.     For   example,  there   are  probably                                                               
legislators who did not obtain the  flu shot even though the cost                                                               
was  covered by  insurance.   As to  the institutional  barriers,                                                               
many  women may  want the  service but  cannot locate  a provider                                                               
with LARC available  at their facility.   The conventional method                                                               
of care in  the healthcare system may not work  and be accessible                                                               
for these  women.   Finally, she stated,  as to  social barriers,                                                               
many women have  misconceptions about LARC because  they have not                                                               
received  proper sexual  education,  or  if they  are  a user  of                                                               
opioids,  they  often  have  a  huge distress  and  fear  of  the                                                               
healthcare system and avoid providers all together.                                                                             
                                                                                                                                
5:08:56 PM                                                                                                                    
                                                                                                                                
MS. MINA referred  to SB 198, Section 1,  subparagraphs (2), (3),                                                               
and (8), page 2, which read as follows:                                                                                         
                                                                                                                                
          (2)  evaluate best  practices  for treating  women                                                                    
     and  children when  there is  a high  risk of  neonatal                                                                    
     abstinence   syndrome   or   fetal   alcohol   spectrum                                                                    
     disorders;                                                                                                                 
                                                                                                                                
          (3) facilitate the creation of an effective                                                                           
     network of hospitals and service;                                                                                          
                                                                                                                                
          (8) provide  a data-driven framework  to establish                                                                    
     a   comprehensive   strategy  for   using   long-acting                                                                    
     reversible  contraception to  reduce the  occurrence of                                                                    
     neonatal   abstinence   syndrome  and   fetal   alcohol                                                                    
     spectrum disorders in the state.                                                                                           
                                                                                                                                
                                                                                                                                
MS.  MINA related  that those  subparagraphs  support a  research                                                               
project  that  aims  at better  strategies  for  women's  health.                                                               
Additionally,  she explained,  as was  heard today,  the concerns                                                               
about coercion will  be acknowledged under the review  of the IRB                                                               
which  specified  room  in  the   study  for  education  and  the                                                               
economies for the women to choose  whether they want to use birth                                                               
control in  the form  of a  LARC.   She described  that substance                                                               
abuse during pregnancy  is a complicated and  sensitive issue and                                                               
it does  require a  nuanced approach in  order to  improve public                                                               
health  for  the most  vulnerable  in  our population,  including                                                               
women and children.  She asked that the committee pass SB 198.                                                                  
                                                                                                                                
5:09:57 PM                                                                                                                    
                                                                                                                                
BESSE  ODOM  advised  that  she   is  representing  herself,  and                                                               
acknowledged  that  the intent  of  the  legislation means  well.                                                               
However, she  asked that the  committee not support this  bill in                                                               
its current  form because it  does not get  to the bottom  of the                                                               
problems for  these particular groups  of women that it  seeks to                                                               
help.  She related that the  state should put more resources into                                                               
programs to help these women in  need.  She said she would rather                                                               
see  the  money  allocated  to  improving  the  already  existing                                                               
programs  and organizations  who aid  women battling  a substance                                                               
abuse disorder.   She  described that  this bill  insinuates that                                                               
these women should have their  rights to have children controlled                                                               
not by  herself, but by  those who they do  not know and  may not                                                               
even  trust.   She  said  that she  genuinely  believes that  the                                                               
research   showing    that   good   educational    programs   and                                                               
accessibility to programs wherein women  can turn their lives and                                                               
situations  around   are  being  ignored.     As  a   woman,  and                                                               
particularly an  African American woman, she  described this bill                                                               
as  highly  insulting  to  her  because it  reminds  her  of  the                                                               
histories told  to her by  women such  as her grandmother.   Many                                                               
women, living around the time  of her grandmother were uneducated                                                               
and lacked  the resources  they needed to  make a  truly informed                                                               
decision  about  their  reproductive  rights  and  their  bodies.                                                               
Historically,  groups  of  women  were targeted  and  sought  out                                                               
because  it  was believed  their  offspring  would be  less  than                                                               
desirable to the population.  This  bill is a great reminder that                                                               
"we  should  be educating  ourselves"  regarding  the history  of                                                               
reproductive rights  and marginalized communities.   These women,                                                               
suffering from substance abuse disorder  and women of color, have                                                               
always  been victims  of violator  reproductive  rights and  this                                                               
bill  in  its current  form  opens  the  door  to the  rights  of                                                               
vulnerable women  being violated.   She described that  this bill                                                               
is also  insulting because  it insinuates  that a  woman battling                                                               
substance abuse disorder is not  fully capable of having children                                                               
and  turning  her  own  life   around  with  the  right  support.                                                               
Clearly, substance abuse  disorder is a huge issue  in this state                                                               
as she  has three  siblings who  battle the  disorder on  a daily                                                               
basis.   Ms. Odem  encouraged the committee  to read  the history                                                               
books, and to  be sympathetic to the groups  of women desperately                                                               
in need  of true support  systems and great  educational programs                                                               
that address their needs.                                                                                                       
                                                                                                                                
CHAIR SPOHNHOLZ left public testimony on SB 198 open.                                                                           
                                                                                                                                
[SB 198 was held over.]                                                                                                         
                                                                                                                                
5:13:19 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 5:13 p.m.                                                                                                          

Document Name Date/Time Subjects
SB 198 Amendment D.4.pdf HHSS 4/19/2018 3:00:00 PM
SB 198
SB 198 Amendment D.9.pdf HHSS 4/19/2018 3:00:00 PM
SB 198
SB 198 Amendment D.12.pdf HHSS 4/19/2018 3:00:00 PM
SB 198
SB 198 Amendment D.13.pdf HHSS 4/19/2018 3:00:00 PM
SB 198
SB 198 Sectional Analysis.pdf HHSS 4/19/2018 3:00:00 PM
SFIN 3/26/2018 9:00:00 AM
SB 198
SB 198 Sponsor Statement.pdf HHSS 4/19/2018 3:00:00 PM
SFIN 3/26/2018 9:00:00 AM
SB 198
SB 198 Supporting Documents - ACT Letter of Support.pdf HHSS 4/19/2018 3:00:00 PM
SFIN 3/26/2018 9:00:00 AM
SB 198
SB 198 Supporting Documents - Alaska Dispatch Article May 2016.pdf HHSS 4/19/2018 3:00:00 PM
SFIN 3/26/2018 9:00:00 AM
SB 198
SB 198 Supporting Documents - JSAT Article.pdf HHSS 4/19/2018 3:00:00 PM
SFIN 3/26/2018 9:00:00 AM
SB 198
SB 198 Supporting Documents - NEJM Study May 2012.pdf HHSS 4/19/2018 3:00:00 PM
SFIN 3/26/2018 9:00:00 AM
SB 198
SB 198 PPVNH_SB 198_LARC study_testimony.pdf HHSS 4/17/2018 3:00:00 PM
HHSS 4/19/2018 3:00:00 PM
SB 198
SB 198 SisterSong LARCStatementofPrinciples.pdf HHSS 4/17/2018 3:00:00 PM
HHSS 4/19/2018 3:00:00 PM
SB 198
SB 198 Guttmacher Policy Review.pdf HHSS 4/17/2018 3:00:00 PM
HHSS 4/19/2018 3:00:00 PM
SB 198
SB 198_LARC study_testimony_PPVNH.pdf HHSS 4/19/2018 3:00:00 PM
SFIN 3/26/2018 9:00:00 AM
SB 198
SB 198 Sectional Analysis.pdf HHSS 4/17/2018 3:00:00 PM
HHSS 4/19/2018 3:00:00 PM
SB 198
SB 198 Sponsor Statement.pdf HHSS 4/17/2018 3:00:00 PM
HHSS 4/19/2018 3:00:00 PM
SB 198
SB 198 Amendment D.14 (revised D.13).pdf HHSS 4/19/2018 3:00:00 PM
SB 198
SB 198 Letter of Support - Judge Steinkruger (retired).pdf HHSS 4/19/2018 3:00:00 PM
SB 198
SB 198 Letter of Support - Judge Steinkruger (retired).pdf HHSS 4/19/2018 3:00:00 PM
SB 198
SB 198 Letter of Opposition - Serene O'Hara-Jolley.pdf HHSS 4/19/2018 3:00:00 PM
SB 198
SB 198 Letter of Opposition - PPVNWH.pdf HHSS 4/19/2018 3:00:00 PM
SB 198