Legislature(1997 - 1998)
01/31/1997 09:00 AM HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE January 31, 1997 9:00 a.m. MEMBERS PRESENT Senator Gary Wilken, Chairman Senator Lyda Green Senator Jerry Ward Senator Johnny Ellis MEMBERS ABSENT Senator Loren Leman, Vice-Chairman COMMITTEE CALENDAR SENATE BILL NO. 24 "An Act relating to a requirement that a parent, guardian, or custodian consent before certain minors receive an abortion; establishing a judicial bypass procedure by which a minor may petition a court for authorization to consent to an abortion without consent of a parent, guardian, or custodian; amending the definition of 'abortion'; and amending Rules 40 and 79, Alaska Rules of Civil Procedure; Rules 204, 210, 212, 213, 508, and 512.5, Alaska Rules of Appellate Procedure; and Rule 9, Alaska Administrative Rules." - HEARD AND HELD SPONSOR SUBSTITUTE FOR SENATE BILL NO. 38 "An Act relating to anatomical gifts, living wills, and do not resuscitate orders." - HEARD AND HELD SENATE BILL NO. 51 "An Act giving notice of and approving the entry into, and the issuance of certificates of participation in, a lease-purchase agreement for a centralized public health laboratory facility." - HEARD AND HELD PREVIOUS SENATE COMMITTEE ACTION SB 24 - See Senate Health, Education & Social Services Committee minutes dated 1/29/96. SB 38 - No previous Senate committee action. SB 51 - No previous Senate committee action. WITNESS REGISTER Peter Nakamura, MD, MPH Director Division of Public Health Department of Health and Social Services P.O. Box 110610 Juneau, AK 99811-0610 POSITION STATEMENT: Answered questions. Sid Heidersdorf Box 658 Juneau, Alaska 99801 POSITION STATEMENT: Supported SB 24. Betty Hall PO Box 22933 Juneau, Alaska 99802 POSITION STATEMENT: Supported SB 24. John Monagle PO Box 210527 Auke Bay, Alaska 99821 POSITION STATEMENT: Supported SB 24. Joelle Hall 11427 Aurora St. Eagle River, AK 99577 POSITION STATEMENT: Opposed SB 24. Sharylee Zachary P.O. Box 1531 Petersburg, AK 99833 POSITION STATEMENT: Supported SB 24. Marilyn George P.O. Box 1031 Petersburg, AK 99833 POSITION STATEMENT: Opposed SB 24. Johanna Munson Mat-Su, Alaska POSITION STATEMENT: Opposed SB 24. Alice Johnstone Sitkans for Choice 213 Shotgun Alley Sitka, AK 99835 POSITION STATEMENT: Opposed SB 24. Pat Yamaguchi Mat-Su, Alaska POSITION STATEMENT: Opposed SB 24. Senator Kelly State Capitol Juneau, Alaska 99801-1182 POSITION STATEMENT: Prime Sponsor of SB 51. Greg Hayes, Dr.PH Chief Laboratories Division of Public Health, DHSS PO Box 110613 Juneau, Alaska 99811-0613 POSITION STATEMENT: Presented a slide presentation regarding SB 51. Senator Taylor State Capitol Juneau, Alaska 99801-1182 POSITION STATEMENT: Prime Sponsor of SSSB 38. Matt Anderson, Training Coordinator Emergency Medical Services Section, DHSS PO Box 110616 Juneau, Alaska 99811-0616 POSITION STATEMENT: Supported the intent of SSSB 38. ACTION NARRATIVE TAPE 97-3, SIDE A Number 001 SB 24 PARENTAL CONSENT BEFORE MINOR'S ABORTION CHAIRMAN WILKEN called the Senate Health, Education and Social Services (HESS) Committee to order at 9:00 a.m. and announced that testimony and deliberations on SB 24 would continue. DR. PETER NAKAMURA , Director of the Division of Public Health, Department of Health and Social Services (DHSS), presented information on questions asked by committee members at the previous hearing. With regard to the number of Native American physicians in Alaska, it is difficult to ascertain because statistics on physicians do not include ethnic identification. Dr. Nakamura was personally aware of five Native American physicians who work for Native corporations and the Public Health Service. Two are female physicians, and of the five, two are Alaska Natives. Other Native American physicians have practiced, and may be practicing in Alaska, however an actual count is not available. To obtain the number of female physicians in Alaska, he counted the number of female physicians licensed in association registers. There are 126. Number 097 DR. NAKAMURA provided a packet of information to committee members regarding the nature of counseling and counselor training. The packet included DHSS information made available to all public health nurses and nurse practitioners, as well as statements and directives of the American College of OBGYN and the residency program. Regarding the psychological impact of abortion on young women, 225 cases were identified in a literature search. The summary of the study performed using those 225 cases is included in the packet. The study dates back to the period when abortions were illegal to the present, and reports trends in terms of the psychological impact on minors who delivered children compared to minors who had abortions. There has been a significant change in those trends. When abortion was illegal, the psychological impact was definitely stronger on those minors who had abortions. With time, education, practice, and better knowledge, a total shift has occurred so that now the stronger psychological impact is on those minors who carry a pregnancy to term. Number 126 SENATOR GREEN questioned the basis upon which Dr. Nakamura's last statement was made. DR. NAKAMURA replied that the information is based on the evaluation of the studies that have been done through this extended period of time. SENATOR WARD asked what dates the 225 cases covered. DR. NAKAMURA said the cases date from the pre-war years to the present. SENATOR WARD asked for the specific years. DR. NAKAMURA was una to cite specific years at that moment, therefore SENATOR WARD note he would get the information at a later time. DR. NAKAMURA responded to the remaining questions from the previous committee hearing. Regarding the risk of breast cancer following an abortion, a study was published in January, 1997 in the New England Journal of Medicine. The study was conducted in Denmark, where registers on abortion are kept, and included 1,500,000 females. The study demonstrated there is absolutely no correlation between the practice of abortion and breast cancer. The study disputed the Harborview study and identified how it was defective. In the Harborview study, a retrospective review was conducted on women with cancer to find out if they had abortions. It was determined women who already had cancer were more readily willing and able to disclose they had abortions, than those who did not have cancer. The use of that group skewed the information measurably. In the Denmark study, names were taken from the registry, which began in 1973, and from records kept prior to that time. The women were contacted to find out whether they did, or did not, have cancer. The results refuted the previous studies. Number 176 SENATOR WARD asked whether the American Medical Association conducted the study in Denmark. DR. NAKAMURA answered no, it was conducted by the Danish medical association. SENATOR WARD asked whether the study was overseen by American doctors. DR. NAKAMURA responded it was not and explained the study was done independently and was reviewed by the scientific community and approved for journal publication. That process takes about one year, sometimes longer. SENATOR WARD questioned whether any American medical doctors participated in the other one. DR. NAKAMURA stated he could not identify them as authors but he could not say they did not participate in any way. He offered to find out the nationalities of the authors. Number 188 Regarding the question on the risk of abortions compared to the risk of term deliveries, DR. NAKAMURA informed committee members that there is no study that he is aware of that demonstrates that the risk of abortion is greater than the risk of a delivery. SENATOR WARD remarked the National Association of Social Workers (NASW) has made the statement that in all cases it is safer to have an abortion than to deliver. He asked Dr. Nakamura if he agreed with that statement. DR. NAKAMURA did not agree that to be true in all cases. SENATOR WARD asked Dr. Nakamura if the NASW's statement was wrong. DR. NAKAMURA replied that would depend on how that comment was stated and what NASW's intent was, and the context in which the statement was made. Number 214 SENATOR WARD said that since he requested the packet of information provided by Dr. Nakamura, he wanted to make sure it was in the packet. He appreciated Dr. Nakamura's testimony that there are two Native female doctors who perform abortions. DR. NAKAMURA clarified the question was not whether those doctors perform abortions, but what the ratio of male and female physicians is in Alaska, and how many physicians are Native Americans. No question was asked regarding the number of physicians who perform abortions. DHSS does not have that information, it does not know which doctors participate in the practice. SENATOR WARD apologized for not making himself clear. He was aware of several instances in the Bush where young Native girls were quite intimidated by the whole process which resulted in an abortion. DR. NAKAMURA noted abortions are not performed anywhere in the rural areas. SENATOR WARD indicated he understood that, which is why he questioned how many peer pressures - how many women or how many Natives actually perform abortions. SENATOR WARD said he now understands that the answer is zero. He asked whether all doctors performing abortions in Alaska have specific training in pre and post abortion counseling, and whether that information is verified in the packet of materials provided by Dr. Nakamura. DR. NAKAMURA maintained the packet does not include signed testimony by every individual physician, because he does not know who they are, however any standards set by any organization that deals with this practice requires practitioners to be well versed in pre and post abortion counseling. The packet contains an outline of those requirements laid out by the American College of OBGYN and the college for OB residency training. SENATOR WARD asked whether a specific training course is required prior to practice. DR. NAKAMURA indicated the training actually begins well before physicians specialize. All physicians are trained in counseling; maybe not specifically in depth in an issue like abortion counseling, but counseling itself is a rather technical procedure that starts with an assessment process that occurs. Number 245 SENATOR WARD asserted he was talking specifically about abortion counseling because he knows of young women who did not receive it in Alaska. He is trying to determine, if in fact, the people who are performing abortions are legally required to have specific training for abortion counseling. DR. NAKAMURA answered they are not required by law. Number 256 SENATOR GREEN acknowledged she was very troubled by Dr. Nakamura's previous testimony and even more troubled after she read the script of his testimony. She asked whether he is the Director of the Division of Public Health. DR. NAKAMURA responded affirmatively. She asked whether he really believed the testimony he provided to the committee, and then read the following paragraph from his testimony: Basic principles of law in society hold that parents should be involved in, and responsible for, assuring appropriate medical care for their children. Parents ordinarily act in the best interests of their children, and minors benefit from the advice and emotional support of their parents. DR. NAKAMURA clarified he said, "minors generally benefit" because it is not 100 percent. SENATOR GREEN asserted he must have some very compelling reasons to justify ignoring the basic laws and principles mentioned. DR. NAKAMURA said "yes." SENATOR GREEN asked if she could infer from his testimony that he believes it is okay for a 16, 15, 14, 13, 12, or 11-year-old girl to have an abortion performed on her body without the knowledge or consent of her parents. DR. NAKAMURA responded that each case is an individual case. To answer Senator Leman's question - in what kind of a situation would he recommend this procedure if a minor refuses to involve her parents - he contacted physicians to request real life scenarios. Dr. Nakamura was told of a young lady who is now hospitalized in an intensive care unit and will be there for about one year, who has feeding and draining tubes, and is on a respirator, because she was unable to obtain an abortion through the legal procedures, and as a result had an illegal septic abortion. In other situations, minors have carried fetuses without a brain or spinal chord and were therefore not viable. In counseling these individuals indicated, in no uncertain terms, they would seek illegal abortions or find some other way to induce the loss of the fetus, significantly increasing complications. There are situations where a parent or custodian has already demonstrated he/she is abusive. One-third of all minors who do not seek parental consent are already in abusive or coercive situations. Over 4,000,000 undergo domestic violence every year and 50 to 55 percent of the children in these families have also been abused. There are situations where it is unsafe for a physician to allow a minor to leave the office. Number 312 SENATOR GREEN did not think this bill would encourage that type of situation. She referred to the following statistics provided by DHSS: 61 percent of unmarried minors inform one or both parents; 20 percent do not inform their parents but involve at least one responsible adult such as clergy, another relative, teacher, counselor or professional other than the principle physician. One- third of minors who do not inform their parents have already experienced family violence and fear it will recur. She asked whether the one-third of minors who do not inform their parents because of the fear of violence would comprise about 14 percent of the total 40 percent who do not inform their parents. That would mean about 86 percent do not experience violence in the home. Dr. Nakamura explained he would like to go back to the articles those numbers were taken from to verify the numbers. SENATOR GREEN stated the inference in the testimony was that one- third of minors are exposed to violence, yet the numbers breakdown to 14 percent. Although 14 percent is unfortunate, actions taken for the general population should not be based on the needs of that limited percent of the population. DR. NAKAMURA noted the 86 percent do not need legislation, it is the 14 percent that do not have a functional relationship with their parents and will now have additional court requirements and abusiveness. That is the group DHSS is concerned about. SENATOR GREEN felt SB 24 would address the next step, a judicial bypass, for the 14 percent. DR. NAKAMURA commented it would force a relationship which could then become even more abusive or detrimental. Dr. Nakamura remarked that the court system is an intimidating process for youngsters, and is a process they are not aware of. SENATOR GREEN doubted it would be more intimidating than subjecting oneself to an abortion without a parent or guardian for guidance. Number 350 SENATOR GREEN indicated she would be submitting more questions to Dr. Nakamura in writing and noted although she has a natural respect for physicians, she was incredibly disappointed in the testimony presented by Dr. Nakamura in opposition to SB 24 and in his representation for DHSS. SENATOR WARD asked Dr. Nakamura to supply to the committee the number of doctors he surveyed to obtain first hand situations in which parental consent would not be justified. DR. NAKAMURA said he spoke to three doctors. SENATOR WARD asked how he decided which doctors to call. DR. NAKAMURA replied he learned through colleagues, and others, these particular doctors had a familiarity with these kinds of problems. Number 373 SID HEIDERSDORF supported SB 24. As the father of three girls, he was disturbed to hear people object to a requirement ensuring that abortion facilities and school counselors would respect his rights and responsibilities as a parent. SB 24 makes good policy because it supports the concept of the family and recognizes that parents are responsible for their children. Minor children are not mature enough to make a decision regarding serious medical matters without parental advice, especially when the decision to have an abortion involves a life or death decision that carries ramifications in later years. Who, better than the parents, has the best interests of their children at heart. In those extreme cases where that is not true, a judicial bypass takes care of that problem. Legislation based on extreme cases is not good law. He asked the committee to support a principle in state law that finds parents to be the best people to provide love and care for their children, regardless of what kinds of statistics are presented. That policy protects the child. The fact remains that a minor child who finds herself pregnant may face incredible pressures from a boyfriend and from abortion counselors at schools. They need other individuals, hopefully the parents, to be involved in the decision. There are plenty of individuals who have come forward and believe they were pressured to have an abortion when they did not want one. He disagreed with prior testimony which categorized pregnant teens into two groups: those who go to their parents no matter what, and those who do not. He believes there is a third group in the middle. SB 24 is for the middle group. Regarding the dire predictions made if SB 24 passes, similar legislation is in effect in many other states with no detrimental effects. He added there is a lot more to the story about the woman who will be hospitalized for a year, referred to by Dr. Nakamura, that was revealed. The negative psychological impacts of abortion are well known by post abortion counselors. Number 446 JOHN MONAGLE , President of Alaskans for Life, testified in favor of SB 24. He was disappointed that the Administration sends representatives to speak of gloom and doom while purporting to be supporters of family, fairness, and justice. Twenty seven states have successfully passed similar legislation. BETTY HALL , representing Black Americans for Life, testified in support of SB 24. As a retired nurse, she finds the lack of the use of a pre-operative checklist by abortionists, to ascertain pre- existing medical conditions, to be most disturbing. She described a case in which a 14-year-old girl had an abortion during which complications occurred, at which point the girl's mother was called to sign a consent form for follow-up treatment. The medical costs amounted to over $30,000. She questioned a policy in which consent is required for follow-up treatment, but not for the abortion. SENATOR WARD shared Ms. Hall's concerns about the lack of any form of counseling guidelines for physicians who perform abortions. He was unsure whether the cases he referred to earlier were unusual, but those women were not fully aware of what happened to them. From their stories, it did not appear they were given any options or counseling. MS. HALL could not speak to counseling since she never attended any abortions, however she believed most girls are told the procedure involves removing a blob of tissue, not a baby, and some of the girls are so young they do not know what they are getting involved in. Number 498 JOELLE HALL testified in opposition to SB 24. She disagreed with Senator Green's conclusion that 14 percent of cases in which the girl does not go to her parents or clergy is too small of a percentage to direct legislation, because that group is the most likely to pursue illegal abortions rather than go a through judicial bypass. It is unacceptable to deny girls their constitutional right and possibly die as a result. Fourteen percent is enough to warrant the protection of the law. SB 24 confuses parental desires with parental rights. SHARYLEE ZACHARY indicated that she was leaning toward supporting SB 24 because it is important to teach children that for every action there is a consequence. Family members stand together to work through the happenings and consequences, learn from them, and encourage each other to make wiser decisions the next time and to be responsible. It is important to teach children the great value and sanctity of life and the value of abstinence until marriage. One reason for the introduction of SB 24 is that many people do not live their lives in such a manner and do not teach these truths to their children. There are many single parent families where there was never a marriage or commitment. There are a multitude of fatherless families living in poverty, and children are joining gangs to find security and a family feeling. Few people are accepting the consequences of their actions. This bill drives a wedge into the parent-child relationship. Parents would not be given a chance to help their child. She questioned whether SB 24 allows people outside of the family to fill their children with the types of lies that will cause them not to live up to their responsibilities. She supported any legislation that does not contribute to the breakdown of families. Number 581 MARILYN GEORGE testified in opposition to SB 24. When working on a crisis line in Idaho, she became aware of how scared teenagers are of telling their parents about a pregnancy. TAPE 97-3, SIDE B Number 587 JOHANNA MUNSON testified in opposition to SB 24. Restrictive bills, such as SB 24, endanger teens' health by inhibiting them from seeking safe medical care early in pregnancy. The Legislature is not in the position to make personal choices for individual teenage women. If the Legislature looked at the facts and was aware of what is really going on with teenage women who get pregnant, it would kill the bill. Statistics reveal that 50 percent of teenagers in the Mat-Su Valley who get pregnant live in homes where they are psychologically or sexually abused. These young teenagers cannot be forced into a position that requires them to consult with their parents. If 60 percent of teenagers do consult with their parents, as statistics indicate, SB 24 will not change that circumstance at all, and the Legislature should be concerned about the other 40 percent. SB 24 might be the worst thing that could be done for the 40 percent. SENATOR WARD commented that he had looked into the teenage pregnancy situation in his communities and his observations differ from Ms. Munson's. He asked her to forward her statistics to the committee. ALICE JOHNSTONE spoke on behalf of herself and for Sitkans for Choice, which represents the majority of women in Sitka who are pro-choice. The real purpose of SB 24 is to prevent abortions. SB 24 will not prevent teen pregnancy or reduce the number of children raising children. In Minnesota, the birth rate among mothers, age 15-17 increased 38.4 percent after enforcement of a parental notification law. Statistics compiled by the federal Center for Disease Control and other sources indicate the risk of death from pregnancy, is, on average, 24 times higher than from the risk of death from abortion at up to 12 weeks of pregnancy. Teenagers are much more likely to suffer medical complications attributable to childbirth, than adults. This bill will create more teenage mothers. There is no bill that will force unwed fathers to not only support, but also participate in rearing their children. The young mother gives up nine months of her life to incubate an unborn infant, then faces the wrenching decision to give it up for adoption or, if she chooses to keep the child, a life of poverty, while the young man responsible gets off scott free. She questioned why SB 24 does not have a fiscal note appropriating funds to support these young mothers and their infants. If Minnesota is an example, Alaska will have a third more unwed mothers who will be applying for welfare. Even better would be an amendment to SB 24 authorizing confidential reproductive health and counseling services which could dispense candid information about sexuality, reproduction, contraception, and the importance of family support and communication. Such programs would help to reduce teen pregnancy and also strengthen family bonds. She urged committee members to pass SB 24 out of committee with "do not pass" recommendations or take action to supply the kind of counseling services mentioned in order to prevent unwanted teenage pregnancies. Number 518 PAT YAMAGUCHI testified in opposition to SB 24 because not all parents communicate with their children, and some teens get pregnant because they lack a social system that supports the parent-child bond. As a pharmacist she has worked in many situations where she has counseled, by the request of the physician and teenager, about choices. Many teenagers do seek counseling from various medical professionals, as well as their church groups, friends, and parents. SB 24 should not be passed until other support systems have been strengthened. CHAIR WILKEN thanked everyone for participating, and announced testimony on SB 24 was closed. He intends to vote on SB 24 as the first order of business on Monday morning. He asked committee members if they preferred to discuss the bill at that time. SENATOR WARD relayed that Ms. Betty Hall asked him to inform committee members that there was an abused young lady who had an abortion and was then sent back to the abusive situation. CHAIR WILKEN announced SB 24 would be taken up as the first order of business on Monday. SB 51 APPROVE CENTRALIZED PUBLIC HEALTH LAB CHAIRMAN WILKEN announced that SB 51 would be the next order of business. The committee recessed at 9:58 a.m., awaiting the arrival of Senator Kelly. The committee was called to order at 9:59 a.m. Number 482 SENATOR KELLY , Prime Sponsor of SB 51, informed the committee that last year this bill passed the House, came to the Senate. There was a great deal of support in the Senate, but the bill was unable to get to third reading on the final day of session and therefore, the bill died. Senator Kelly believed that in the zeal to close the fiscal gap, capital facilities throughout Alaska are being overlooked. In spite of the fiscal gap, Alaska will have to work something out within the long-range strategy in order to invest more money in capital projects. Senator Kelly said that SB 51 is a good first step and indicated that he is working on another plan. CHAIRMAN WILKEN noted that Forrest Browne from the Department of Revenue was present in order to answer questions as well as Tom Lane from the Division of Administration in DHSS. Number 453 DR. GREG HAYES , Chief of the Section of Public Health Laboratories in DHSS, informed the committee that he had been in Alaska for three years. Prior to that, Dr. Hayes was the Director of the Public Health Laboratories for Indiana. Dr. Hayes discussed his education in this field. The new consolidated Public Health Laboratory facility addressed in SB 51 would be located in Anchorage. The new facility would include the functions of the Anchorage and Juneau Public Health Laboratories and the Medical Examiner's Laboratory. Design and construction costs would be paid through debt financing through the sale of certificates of participation for a lease purchase of the facility. The services of the State Public Health Laboratory are directed towards prevention and control of disease in the community which differs from clinical laboratories focusing on individual care. The Public Health Laboratory focuses on communicable disease testing and work in partnership with the Centers for Disease Control and private laboratories in Alaska. The Public Health Laboratory fulfills an assessment, policy development and assurance role. Advanced testing for infectious agents not routinely performed in the private sector are performed by the Public Health Laboratory. Data is constantly being gathered for targeted disease control efforts. In the event of an epidemic, the Public Health Laboratory is able to apply state of the art technology for rapid testing of large numbers of specimens. Furthermore, the Public Health Laboratory specializes in disease surveillance and the recognition of new and reemerging diseases. Number 425 Dr. Hayes reviewed some examples of how the Public Health Laboratory has benefited Alaskans. The State Laboratory provides essential services for disease surveillance, control, and prevention as well as recognition of new and emerging diseases. Alaska's Public Health Laboratory is an essential component of the state and national public health system. Moreover, the State Public Health Laboratory's mission is to provide scientific and technical information for disease prevention and is Alaska's first line of defense for recognizing and controlling the spread of communicable diseases. Dr. Hayes reviewed the core functions of the Public Health Laboratory which are very different from the role of a private clinical laboratory. Dr. Hayes pointed out that even the most ardent supporters of governmental privatization are reluctant to argue for privatizing the public health function. All 50 states and U.S. territories have public health laboratories of which none are privatized. Dr. Hayes discussed the criteria commonly used by state governments in order to determine whether privatization is appropriate or not. None of the criteria fit the Public Health Laboratory. He noted that if testing were privatized, multiple contracts would be necessary since no one private laboratory performs all types of testing currently performed at the State Public Health Laboratory. Furthermore, for many tests there are no private laboratories that perform the test. The few tests that a private laboratory could perform would merely be added to its current work load being sent out of state. Number 347 Dr. Hayes explained why a new facility is necessary. Two of the facilities are in disrepair with mechanical and structural inadequacies for conducting laboratory testing. The laboratories are in leased space with poor facility layouts and space limitations for future growth. The Juneau and Anchorage facilities have major health and safety concerns such as inadequate ventilation systems for working with infectious organisms. The Juneau and Anchorage facilities also have inadequate wiring. Dr. Hayes discussed specific examples of these problems. Further, the State Medical Examiner needs to find a permanent home. Currently, the Medical Examiner resides in the Department of Public Safety's Crime Detection Laboratory. The Crime Laboratory needs this space in order to develop a much needed DNA analysis laboratory. Dr. Hayes stated that construction of a new facility would save the state money. An unrecoverable investment would be necessary to repair the current facilities, and consultants say that the facilities could not be brought up to code. A new facility would maintain an essential public health service more cheaply and more efficiently. The duplication of activities at multiple locations would not be necessary. Dr. Hayes stated that a new facility would solve the following problems: the fragmentation of services, leased and temporary space, current facilities ill design for current operations, a significant capital investment to fix current facilities although the facilities would not meet code, and the state does not need nor can it afford four separate facilities. Dr. Hayes noted that there have been 14 separate studies since 1985 regarding how to correct problems and position the state laboratories for the future. The conclusion of these studies strongly support the construction of a new facility. In the first year of occupancy, a new facility would save the state $293,000 and would save DHSS approximately $218,000 in personnel and lease costs. Further, the Department of Administration would save $75,000 in lease costs. The cost of the new facility is estimated to be $18,440,000 with annual payments of $2,420,000 for 10 years with a total estimated debt of $24,130,000. The costs from last year's proposal have been adjusted for inflation and the assumptions of the coroner's responsibilities by the Medical Examiner's Program. With regard to the Medical Examiner, it is imperative that the Medical Examiner Laboratory be near Public Safety's Crime Detection Laboratory due to their close interaction and cooperation. Dr. Hayes presented a map depicting the most desirable sites for this project. In conclusion, Dr. Hayes requested the committee's support of this projects. Number 273 SENATOR ELLIS asked if the new facility would be able to accommodate the functions of the Fairbanks laboratory at some point in the future. DR. HAYES said that would be a new project. Funds were cut from last year's bill for a centralized laboratory, so Fairbanks was not included in the project. SENATOR ELLIS asked if Alaska's public health mission made more sense if the Fairbanks laboratory were consolidated with the facility in Anchorage. Is that the most ideal situation? DR. HAYES said that would be a matter of opinion. From his perspective in last year's bill, a centralized option was in the best interest of the state. However, that has changed through the political process. SENATOR ELLIS inquired as to if this project would include the possibility of an addition for future needs. DR. HAYES explained that when the meeting with the architects occurs, there is a certain footage included for the growth in any new building. If additional space for the future can be had, it will be planned in the building. In response to Senator Ellis, Dr. Hayes believed that there is a yearly lease arrangement for the Fairbanks laboratory. TOM LANE interjected that the lease is from the University and there is no concern for the future. DR. HAYES noted that the Juneau Laboratory is on a monthly lease. DR. MICHAEL PROPST , the State Medical Examiner, said that he was present to answer questions. Number 231 MARILYN GEORGE said that Dr. Hayes did not seem to take into consideration the weather in Alaska. The ability to send the tests to Juneau is important. Often, the planes do not get in. The Juneau Laboratory does the microbiology, and often time is of the essence with the results. Ms. George believed that the Juneau Laboratory should not be closed. She also mentioned the job displacement created by the closure of the Juneau Laboratory. CHAIRMAN WILKEN asked if anyone else wanted to testify. Hearing none, he announced that a vote on SB 51 would taken on Monday. SENATOR GREEN pointed out that SB 51 does not include a location. She agreed to talk with Senator Kelly regarding this issue. SENATOR KELLY reiterated the importance to place the facility adjacent to the Crime Laboratory as explained by Dr. Hayes. SENATOR GREEN thought this would be a great facility to be located in the Mat-Su. Number 164 SB 38 ANATOMICAL GIFTS,LIVING WILLS & DNR ORDER CHAIRMAN WILKEN introduced SSSB 38 as the final order of business before the committee. SENATOR TAYLOR , Prime Sponsor of SSSB 38, said that SSSB 38 would modify existing statutes regarding living wills and organ donors. He explained that those provisions are found in different sections and titles which creates some confusion. Often hospitals and EMTs do not know if a living will exists or if a person is an organ donor. Senator Taylor informed the committee that he had been to a dinner at Providence Hospital in which statistics were revealed indicating that living wills are being disregarded by care giving institutions. Much of the reason for that can be attributed to the ineffective manner in which this information is communicated. Therefore, SSSB 38 would at least address those with driver's licenses. The drivers' license would have a notice communicating whether the person has a living will or is an organ donor or not. Senator Taylor discussed statistics regarding the number of organ donor recipients and those still waiting. Anything facilitating this process is necessary. Senator Taylor indicated that by adding this information to the drivers' license, there could be a central depository at some point. That notion is being reviewed as a possible amendment to the legislation. He discussed how a policeman can, in minutes, access much information about a person from their license plate number. Senator Taylor expressed excitement with the possibility that this same sort of system could be utilized by an EMT or hospital simply by using the driver's license in order to obtain information regarding a living will or organ donation. TAPE 97-4, SIDE A Number 007 SENATOR TAYLOR concluded by pointing out that if the statistics from Providence Hospital are to be believed, there are many people administering medical care in good faith to those who have specifications stating otherwise. SENATOR GREEN pointed out that SSSB 38 is before the committee, not SB 38. SENATOR ELLIS asked Senator Taylor if he contemplated that there would be a sticker indicating a living will on the license and if no sticker was present, then normal medical care would be given. SENATOR TAYLOR expressed concern with the sticker falling off. Senator Taylor would like to place this information on the back of the license before the license is laminated. Perhaps, the entire living will could be placed on the license so that when the license was swiped the information would be available. Before that can be achieved, the care providers should at least be able to see an indicator on a license which would prompt a call to a local dispatcher who can access the information. SENATOR ELLIS asked if there was any change in the nature of the living will. SENATOR TAYLOR replied, no, and explained that now the living will and organ donor application would be on the same form. CHAIRMAN WILKEN noted that he had just renewed his license and has a sticker which he did not believe would come off. SENATOR TAYLOR emphasized that this procedure will take a number of years before it becomes effective on licenses due to the fact that licenses are good for five years. SENATOR ELLIS asked if the bill required the DMV to talk to people or have information in the mail-in for license renewals. SENATOR TAYLOR believed that the DMV would ask a person if they have a living will just as the DMV already asks if a person is interested in being an organ donor. CHAIRMAN WILKEN invited Mr. Anderson to give his testimony. Chairman Wilken also informed the committee that SSSB 38 would be voted on Monday. Number 121 MATT ANDERSON , Emergency Medical Services Training Coordinator for the Section of Community Health & Emergency Medical Services, informed the committee that he was involved in Alaska's Do Not Resuscitate protocols. As a result, he was in frequent contact with EMS agencies, fire departments, and hospice organizations. Therefore, SSSB 38 became of interest to Mr. Anderson. Mr. Anderson identified the following two goals as the most important: the visibility of the program and the ease with which on-scene responders can identify those persons who have executed these provisions. Mr. Anderson noted that DHSS would have to develop symptoms and designs for cards and jewelry indicating a persons participation in these procedures. No national insignias have been identified. Mr. Anderson pointed out that with the development of these standardized designs, the public will expect there to be a system in place to deal with the procedures. Currently, the bill does not address this aspect nor does DHSS' fiscal note. Providing very clear guidelines to the 4,000 licensed and certified emergency responders is of major importance. Mr. Anderson informed the committee that there is a Do Not Resuscitate (DNR) program in place with a standardized insignia and requested that program be left in place and only enhanced by this legislation. Perhaps, this would be an appropriate time to add language requiring the State Medical Examiner's permission prior to the decedent's tissue and organs being released for donation. In conclusion, DHSS is in support of the intent of SSSB 38. Number 174 JUANITA HENSLEY , Chief of Drivers Services for the Division of Motor Vehicles, explained that when a person is at the DMV counter to apply or renew a drivers' license the counter person is instructed by law to ask the individual if he/she would like to be an organ donor. If the individual wants to be an organ donor, a card is signed by the individual and witnessed by the counter person and subsequently laminated. The individual receives the laminated card with his/her license and a sticker indicating the individual is an organ donor is placed on the drivers' license. Ms. Hensley informed the committee that the organ donor notation is not placed inside the laminate of the drivers' license because the DMV believes that a person can revoke the organ donor choice at any time during the license period. The living will identification could be added to the card with the organ donor information. Ms. Hensley stated that this information cannot be placed on the back of the license because there is not enough room. Further, the separate card allows the individual to retain the ability to revoke a living will, a do not resuscitate order, and an organ donor notification. With regards to the indicator on the system so that a dispatcher would have access to this information, that could be programmed into the system. Ms. Hensley pointed out that if this information is programmed into the system, then the individual would have to contact DMV in order to revoke one or all of these specifications. The DMV wants to keep people out of the office, therefore Ms. Hensley said that she would want to discuss that with the sponsor in order to determine how to make the process viable. Number 224 SENATOR ELLIS asked if a sticker on the license would still be used. JUANITA HENSLEY explained that the sticker would still be used indicating an organ donor and now there would be a sticker indicating the presence of a living will. Ms. Hensley reiterated that there would be nothing added to the back of the license. The individual would receive a separate laminated card specifying an organ donor, a living will and/or a do not resuscitate order. The individual could revoke these specifications at any time by destroying the card and the sticker, there is no need to contact the DMV because there is no record of the specifications. SENATOR ELLIS believed that the bill, as the sponsor statements indicated, goes further than the second laminated card and the stickers. SENATOR TAYLOR interjected that his previous comments spoke to his hope for the future. In response to Senator Ellis, JUANITA HENSLEY said that there would be no additional record keeping required on the part of DMV under this legislation. If the desire is to have these specifications in a database, that would require program changes and funding for those changes. SENATOR TAYLOR inquired as to what happens to the separate laminate card. JUANITA HENSLEY reiterated that the separate laminated card is given to the individual to carry with their drivers' license. There is no information on who is an organ donor at the DMV. SENATOR ELLIS did not recall being informed of his ability to revoke his designations; he thought that the DMV kept a record. SENATOR TAYLOR clarified that this legislation would merely add another sticker on the front of the license with the separate laminated card. CHAIRMAN WILKEN informed everyone that votes on SB 24, SB 51, and SSSB38 would be taken at Monday's meeting. There being no further business before the committee, the meeting was adjourned at 10:55 a.m.