Legislature(2013 - 2014)BELTZ 105 (TSBldg)
02/27/2013 01:30 PM Senate JUDICIARY
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| SB49 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 49 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
SENATE JUDICIARY STANDING COMMITTEE
February 27, 2013
1:34 p.m.
MEMBERS PRESENT
Senator John Coghill, Chair
Senator Lesil McGuire, Vice Chair
Senator Fred Dyson
Senator Donald Olson
Senator Bill Wielechowski
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
SENATE BILL NO. 49
"An Act defining 'medically necessary abortion' for purposes of
making payments under the state Medicaid program."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 49
SHORT TITLE: MEDICAID PAYMENT FOR ABORTIONS; TERMS
SPONSOR(s): SENATOR(s) COGHILL
02/11/13 (S) READ THE FIRST TIME - REFERRALS
02/11/13 (S) JUD, FIN
02/15/13 (S) SPONSOR SUBSTITUTE INTRODUCED-REFERRALS
02/15/13 (S) JUD, FIN
02/27/13 (S) JUD AT 1:30 PM BELTZ 105 (TSBldg)
WITNESS REGISTER
CHAD HUTCHINSON, Staff
Senator John Coghill
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Introduced SSSB 49 on behalf of the sponsor.
PRICILLA K. COLEMAN, PhD., Professor
Bowling Green State University
Bowling Green, OH
POSITION STATEMENT: Provided statistics to support SSSB 49.
JOHN THORP, MD.
University of North Carolina
Chapel Hill, NC
POSITION STATEMENT: Provided testimony that supported SSSB 49.
SUSAN RUTHERFORD, MD.
Redmond, Washington
POSITION STATEMENT: Provided testimony that supported SSSB 49.
ACTION NARRATIVE
1:34:34 PM
CHAIR JOHN COGHILL called the Senate Judiciary Standing
Committee meeting to order at 1:34 p.m. Present at the call to
order were Senators Dyson, McGuire, Wielechowski, and Chair
Coghill. Senator Olson arrived soon thereafter.
SB 49-MEDICAID PAYMENT FOR ABORTIONS; TERMS
1:34:43 PM
CHAIR COGHILL announced the consideration of SSSB 49. Speaking
as the prime sponsor, he stated that the bill intends to add
clarification.
1:35:54 PM
CHAD HUTCHINSON, staff to Senator John Coghill, sponsor of SB
49, stated that this legislation has been years in the making
and has gone through a thorough, clinical analysis by both legal
and medical experts. It is about defining what a medically
necessary abortion is for the purposes of making payments under
Medicaid.
He clarified that there is no intent to reargue the 2001 Planned
Parenthood case. The sponsor recognizes that Alaska has the
constitutional guarantee to provide medically necessary care for
qualified people of limited resources, including women
requesting medically necessary abortions. The difficulty is that
no one has defined what that is, so SB 49 seeks to provide that
definition.
MR. HUTCHINSON stated that the definition provided in the bill
incorporates the statutory foundation required by the federal
Hyde Amendment. That amendment is an important component in a
lot of abortion legislation and was included in an executive
order by President Barak Obama in 2010.
1:38:27 PM
SENATOR OLSON joined the committee.
MR. HUTCHINSON read a portion of the policy stated in Section 1
of Executive Order 13535 of March 24, 2010 as follows:
Following the recent enactment of the Patient
Protection and Affordable Care Act, it is necessary to
establish an adequate enforcement mechanism to ensure
that Federal funds are not used for abortion services
(except in cases of rape or incest, or when the life
of the woman would be endangered), consistent with a
longstanding Federal statutory restriction that is
commonly known as the Hyde Amendment.
MR. HUTCHINSON relayed that those provisions are included in the
definitional language of SB 49. He directed attention to tab 7,
which has up to date language with regard to what the Hyde
Amendment says, and suggested members compare that language with
what is included in the bill.
He pointed out that the Alaska Constitution requires protection
that is higher than the federal standard, and the bill reflects
that added protection in subsection (b)(4) on page 2. He noted
that the provisions in this section were taken directly from the
2001 Planned Parenthood case or provided by the sponsor's
medical experts.
1:41:55 PM
MR. HUTCHINSON directed attention to the sectional under tab 3
and explained that it contains the foundational elements for
putting the bill in context. He reiterated that the bill only
defines medically necessary abortions for the purposes of making
payments under Medicaid. The intent is to distinguish between
what constitutes a medically necessary abortion and an elective
abortion.
He clarified that Medicaid does not fund elective procedures
and, therefore, should not fund elective abortions. Medicaid is
required to fund medically necessary procedures and, therefore,
is required to fund medically necessary abortions.
MR. HUTCHINSON directed attention to tab 4a and the Guttmacher
Institute document titled "State Policies in Brief as of
February 1, 2013 - State Funding of Abortion Under Medicaid." He
pointed out that the background statement, in part, says, "At a
minimum, states must cover those abortions that meet the federal
exceptions." The document highlights that 32 states and the
District of Columbia meet the minimum federal standard and allow
state funding of abortion under Medicaid in the circumstance of
life endangerment, rape, or incest. It further highlights that
17 other states, including Alaska, fund all or most medically
necessary abortions either voluntarily or by court order. Mr.
Hutchinson noted that the court order refers to the 2001 Planned
Parenthood case.
He directed attention to tab 4c, which contains the Supreme
Court of Alaska case State of Alaska, Department of Health &
Social Services v. Planned Parenthood of Alaska, Inc. The
conclusion, found on page 16, includes the following statement:
The State, having undertaken to provide health care
for poor Alaskans, must adhere to neutral criteria in
distributing that care. It may not deny medically
necessary services to eligible individuals based on
criteria unrelated to the purposes of the public
health care program.
MR. HUTCHINSON stated that SB 49 seeks to define medically
necessary services based on mutual criteria, directly related to
a health care program. He said the committee would hear
testimony from experts who would clarify specifically what they
believe to be a medically necessary condition in order to
qualify for Medicaid funding for an abortion. He highlighted
that the sponsor reasonably believes that Medicaid is currently
paying for both elective abortions and medically necessary
abortions.
1:46:03 PM
MR. HUTCHINSON directed attention to tab 8 and the document from
the Alaska Bureau of Vital Statistics showing induced
termination of pregnancy statistics for 2011. He reported that
Table 18 shows that the total number of induced terminations was
1,627. The total paid for by Medicaid was 623, or approximately
38.3 percent. He said the general presumption is that those
women who qualified stated that there was a rape, incest, it was
medically necessary, or the life of the mother was at stake.
MR. HUTCHINSON directed attention to tab 9 and the article from
the Guttmacher Institute titled "Reasons U.S. Women Have
Abortions: Quantitative and Qualitative Perspectives." On page
114, Table 3 indicates that in 2004, only 4 percent of women
having an abortion listed a physical problem with their health
as their most important reason for having the abortion, and less
than 0.5 percent listed being a victim of rape as their most
important reason for having the abortion. Mr. Hutchinson said
that these statistics demonstrate that only a small portion of
abortions are medically necessary.
He emphasized that the foregoing statistics show that the
definition is unclear and that there are no clear guidelines to
differentiate between elective and medically necessary. He again
stated that SB 49 corrects that by bringing clarity to the
definition.
MR. HUTCHINSON noted that tabs 11, 12, and 13 have the curricula
vitae (CV) of the experts providing testimony today.
1:48:56 PM
SENATOR WIELECHOWSKI asked if under the Medicaid provisions,
Alaska is required to pay for abortions when a doctor certifies
that it is medically necessary.
MR. HUTCHINSON deferred the question to someone from the
Department of Health and Social Services (DHSS).
SENATOR WIELECHOWSKI asked if he was saying that Medicaid was
paying for elective abortions in Alaska.
MR. HUTCHINSON responded that elective procedures are not
supposed to be covered under Medicaid. Only medically necessary
procedures qualify for Medicaid funding.
SENATOR WIELECHOWSKI asked if he had any evidence of any
abortions in the state of Alaska that have been paid for by
Medicaid and were elective as opposed to medically necessary.
MR. HUTCHINSON replied that the statistics he cited show that is
occurring.
1:51:01 PM
SENATOR WIELECHOWSKI asked if the law in Alaska is that Medicaid
funds medically necessary abortions.
MR. HUTCHINSON agreed that is correct.
SENATOR WIELECHOWSKI asked if he had any specific case evidence
of any abortions that Medicaid paid for that were not deemed
medically necessary by a doctor.
MR. HUTCHINSON responded that in coordination with the
Department of Health and Social Services (DHSS) he would follow
up with additional information.
SENATOR WIELECHOWSKI asked if he agreed that under current law
it would be illegal to fund an abortion that is not medically
necessary.
MR. HUTCHINSON agreed that the Alaska Supreme Court said the
state has to fund medically necessary abortions under Medicaid.
CHAIR COGHILL, speaking as the prime sponsor, said he believes
the state has been funding elective abortions, and the bill
seeks to answer the question definitively.
SENATOR WIELECHOWSKI asked if he was aware of a single case in
Alaska where a doctor certified that an abortion performed under
Medicaid was elective.
MR. HUTCHINSON responded that the sponsor is aware in the sense
that the statistics support the fact that medically necessary
has included both elective abortions and medically necessary
abortions under the definitions provided in tabs 8 and 9. He
offered to follow up and provide additional information.
1:53:05 PM
CHAIR COGHILL added that to his knowledge there has been no
prosecution of an elective abortion funded under Medicaid. He
offered his belief that the Supreme Court case caused doctors to
question when it is medically necessary, and the proposed
definition goes to that question.
SENATOR WIELECHOWSKI asked if a woman's physician or a bunch of
politicians is in a better position to decide whether a medical
procedure is medically necessary.
MR. HUTCHINSON offered his belief that clarification is
necessary so that doctors have a clear understanding of the
definition for purposes of payment under [Medicaid]. He added
that women can still get an abortion; the issue is whether it is
paid for by Medicaid.
SENATOR WIELECHOWSKI offered his belief that the issue actually
is constitutional rights according to the Alaska Supreme Court.
MR. HUTCHINSON responded that the purpose of the bill is to
clarify the overly broad definition so everyone understands the
difference between an elective procedure and a medically
necessary procedure.
SENATOR COGHILL, speaking as the prime sponsor, stated that the
bill does not address the constitutional issue. The issue is one
of payment. At this point, it is not to restrict abortion. He
said the question is when is an abortion elective and therefore
paid by for by the woman, and when is it medically necessary and
therefore paid for by Medicaid.
1:55:40 PM
CHAIR COGHILL noted that he called on three professionals to
help make the medical case today, but that there would be
opportunities for other professionals to provide testimony.
1:56:11 PM
PRICILLA K. COLEMAN, PhD., Professor, Bowling Green State
University, said she is a developmental psychologist and
professor of human development and family studies. She has
published over 50 peer-reviewed scientific articles, 37 of which
are on the psychology of abortion. She relayed that based on her
expertise she is often called upon to serve as a content expert
in state civil cases involving abortion. She said that the
opinions expressed in her testimony are based on her education,
professional experience, her personal psychological research,
and her ongoing review of the abortion and mental health
literature.
She stated that, with a reasonable degree of scientific and
medical certainty, she can say that abortion is a substantial
contributing factor in women's mental health problems. She
continued to offer her opinion that abortion is a particularly
risky choice for women with preexisting mental illness. She said
there is no empirical evidence that documents mental health
benefits to women with or without preexisting mental illness,
but there is abundant literature that documents the association
between abortion and declining mental health. Dr. Coleman said
it is therefore her opinion that abortion is never justified
based on mental health and the State of Alaska should not pay
for an abortion when a woman has any form of mental illness.
DR. COLEMAN reported that the formal study of the psychology of
induced abortion has gathered considerable momentum in the past
several decades and the scientific rigor of published studies
has likewise increased. She said the literature has focused on
the potential negative psychological consequences of induced
abortion and the risk factors for such consequences. At the same
time, there has been a growing awareness in the medical
community of the need for evidence-based practice.
DR. COLEMAN said that most of the scientific evidence indicates
that abortion is a substantial contributing factor in women's
mental health problems, including depression and death from
suicide. Anxiety, substance abuse, and relationship problems are
also associated with abortion. She said that this scientific
evidence is published in leading peer-reviewed journals and
fortified by many prospective studies, so there is confidence in
the results. She noted that the testimony she submitted
includes: Exhibit A - "Bibliography of Peer-Reviewed Studies on
Abortion and Mental Health;" Exhibit B - "Evidence for a Causal
Association between Abortion and Mental Health Problems;" and
Exhibit C - a report of a meta-analysis she conducted that was
published September 1, 2011 in the "British Journal of
Psychiatry" titled Abortion and Mental Health: A Quantitative
Synthesis and Analysis of Research Published from 1995-2009.
DR. COLEMAN explained that a meta-analysis is a quantitative
statistical review of literature wherein the data is converted
to a common metric to derive the overall measure of effect. This
methodology gives the results more credibility than the results
from any individual empirical study or narrative review. She
explained that in a meta-analysis, the weighting of any
particular study to the final result is based on scientific
criteria, not an individual opinion.
She reported that the sample in this meta-analysis consisted of
22 studies, 36 measures of effect, and 877,297 participants,
163,880 of which experienced an abortion. The results indicate
that women who aborted experienced an 81 percent increased risk
for mental health issues. She said that when compared
specifically to unintended pregnancy delivered, the women had a
55 percent increased risk of experiencing mental health
problems.
DR. COLEMAN said that separate effects were calculated based on
the type of mental health outcome and the results showed the
following increased risks: anxiety disorders 34 percent,
depression 37 percent, alcohol use/abuse 110 percent, marijuana
use/abuse 220 percent, and suicide behaviors 155 percent. The
composite population attributable risk (PAR) statistic indicated
that 10 percent of the mental health problems were directly
attributable to abortion. She emphasized that stringent
inclusion criteria were used to avoid bias.
She said that the literature on risk factors for adverse post-
abortion psychological consequences is well developed. These
include: prior mental health problems, difficulty with the
decision, emotional investment in the pregnancy, timing during
adolescence or being unmarried, involvement in unstable or
violent relationships, conservative views of abortion and/or
religious affiliation, second trimester abortions, and feelings
of being forced into abortion. She said that internalized
beliefs about the humanity of the fetus, moral, religious, and
ethical objections to abortion, and feelings of bereavement or
loss also distinguish those who suffer.
DR. COLEMAN reported that a well-known abortion provider in 1990
emphasized the role of pre-abortion counseling to evaluate
mental status and abortion readiness while stressing the
importance of a supportive relationship between the counselor
and patient to prevent complications.
She related that for the purpose of litigation in South Dakota
she searched professional literature for studies published
between 1970 and 2011, documenting personal, demographic,
situational, and relational factors that increase the likelihood
of post-abortion psychological problems. She identified 12 risk
factors that were documented in at least 10 peer-reviewed
journal articles. The risk factors include: 1) Character traits
indicative of emotional immaturity, emotional instability, or
difficulties coping - 42 studies. 2) Pre-abortion mental health
or psychiatric problems - 35 studies. 3) Decision ambivalence,
decision doubt, or decisional distress - 29 studies. 4)
Conflicted, unsupportive relationships with others - 28 studies.
5) Conflicted, unsupportive relationship with father of child -
24 studies. 6) Desire for the pregnancy, psychological
investment in the pregnancy, belief in the humanity of the fetus
and/or attachment to the fetus - 21 studies. 7) Repeat or second
trimester abortion - 19 studies. 8) Timing during adolescence or
younger age - 18 studies. 9) Religious, frequent church
attendance, personal values conflict with abortion - 18 studies.
10) Negative feelings and attitudes related to the abortion - 16
studies. 11) Pressure or coercion to get the abortion - 10
studies. 12) Indicators of poor quality abortion care - 10
studies.
2:07:46 PM
DR. COLEMAN concluded that her opinion is that there is never
justification for abortion on mental health grounds, because the
evidence suggests that an abortion will exacerbate pre-existing
mental illness and has significant potential to initiate mental
illness in women without a prior history. She continued that
there is no scientific evidence that women with mental illness
are best served by the provision of abortion services when
facing an unplanned pregnancy, and she does not believe that
public funds should be used for this purpose.
2:08:51 PM
SENATOR WIELECHOWSKI asked if she prepared and delivered a
PowerPoint presentation on abortion where she said:
We need to develop organized research communities to
continue the research, apply for grants, recruit young
academics, critic data produced by pro-choice
researchers, challenge politically biased professional
organizations, train experts to testify, and
disseminate cohesive summaries of evidence.
DR. COLEMAN said yes; it was in the context of a presentation to
the American Association of Prolife OBGYNs.
SENATOR WIELECHOWSKI asked if she issued a report in 2009 for
the Journal of Psychiatric Research linking abortion and mental
health, much like the testimony today.
DR. COLEMAN said yes; an abundance of research documents that
increased risk.
SENATOR WIELECHOWSKI asked if the Guttmacher Institute wrote an
article about her report in the Journal of Psychiatric Research
titled, "Study Purporting to Show Link between Abortion and
Mental Health Outcomes Decisively Debunked."
DR. COLEMAN said that article was not related to the meta-
analysis. It refers to one paper that had an error that was
corrected. The article is still a publication in the journal and
the findings are considered credible. She acknowledged that the
meta-analysis was challenged many times, and opined that it was
because she was providing information that was not politically
correct and contrary to some agendas. She said she was able to
address the criticisms, but she believes that the problem is
that people aren't familiar with a quantitative review. They're
more accustomed to the biased, politically driven summaries
offered by professional organizations. For example, the American
Psychological Association over three decades ago declared a
prochoice position without data to support that position.
CHAIR COGHILL asked if it was true that the Guttmacher Institute
has a particular point of view.
DR. COLEMAN said that is her belief.
2:12:17 PM
SENATOR DYSON asked Dr. Coleman her perspective, because he
always thought the Guttmacher Institute reporting was credible
with regard to numbers of abortions.
DR. COLEMAN said it is the largest body providing data on
abortions, and it also has a history of being connected with
prochoice groups.
SENATOR DYSON recalled seeing statistics from the Guttmacher
Institute that show that a small percentage of abortions are
done for medical reasons. He said he assumes that the statistics
are reasonable accurate.
DR. COLEMAN said she was not prepared to critique their methods,
but the basic information is likely accurate.
2:14:30 PM
SENATOR WIELECHOWSKI asked if she agreed with the statement
Julia Steinberg made after the Journal of Psychiatric Research
reviewed her article in 2009. Dr. Steinberg said:
This is not a scholarly difference of opinion; their
facts were flatly wrong. This was an abuse of the
scientific process to reach conclusions that are not
supported by the data. The shifting explanations and
misleading statements that they offered over the past
two years served to mask their serious methodological
errors.
DR. COLEMAN refuted Dr. Steinberg's statement.
CHAIR COGHILL asked if her perspective is that mental conditions
like bipolar should not be included in the definition of medical
necessity.
DR. COLEMAN agreed saying that it's likely that providing
abortions for women who have serious mental health problems will
result in more claims related to mental health problems
following the abortion. She continued that it is her opinion
that nothing in the literature justifies providing abortion
services for mental health reasons, so an abortion is never
medically necessary.
2:16:16 PM
SENATOR WIELECHOWSKI asked if she believes that she is in a
better position to evaluate a woman's need for medical care than
the woman's personal physician.
DR. COLEMAN said that doctors ought to be informed by the
literature, and their advice should be based on what multiple
professions know. She said she would ask the doctor the basis of
his/her opinion.
SENATOR WIELECHOWSKI asked if it was correct that she couldn't
have that conversation if this bill were to pass.
DR. COLEMAN said the point is that anyone dealing with a woman
who is trying to decide whether to have an abortion or not
should be informed by the literature. She said it is her opinion
that it would be unethical for a doctor to tell a woman with a
medical health problem that she would be better served if she
aborted.
SENATOR WIELECHOWSKI pointed out that she is saying that she is
in a better position to make that determination than the woman's
doctor.
CHAIR COGHILL summarized his understanding of the testimony,
which is that there is no psychological reason to abort a child.
DR. COLEMAN said that is correct.
2:18:54 PM
JOHN THORP, MD., University of North Carolina, said he is an
obstetrician who has practiced maternal fetal medicine, high-
risk obstetrics, since 1983. He provided his credentials as a
professor in the schools of medicine and public health. He noted
he has had over 300 peer-reviewed publications.
DR. THORP related that he worked with the sponsor's staff to
develop a list of conditions that unequivocally threaten the
life of a mother and would constitute a solid medical indication
for a termination of pregnancy. These are conditions that would
be recommended as options to protect a woman's health, even for
women who wanted to continue their pregnancy or who would not
consider abortion.
He noted that he has had experience in suburban/rural areas with
a large Native American population and many military personnel,
where the issue of the use of federal or state funds for
pregnancy termination is a frequent topic.
He opined that the comprehensive list in the bill of conditions
has enough specificity about the degree of severity that would
be helpful to the state of Alaska as it tries to work on the
legislation.
2:22:55 PM
CHAIR COGHILL mentioned the previous testimony talking about
psychological issues, and noted Dr. Thorp's testimony is about
the physical risk to the life and physical health of the mother.
He inquired if most of the situations listed in the bill are in
the category of life endangering.
DR. THORP said yes.
CHAIR COGHILL noted that, for the most part, the list came from
the Supreme Court.
2:24:27 PM
SENATOR DYSON suspected that after a pregnant woman has been
subject to an accident, there may be circumstances to consider
that would lead to the termination of the pregnancy.
DR. THORP replied that, short of massive bleeding, termination
of pregnancy is always an elective procedure. He said that the
physician would treat the trauma and a pregnancy makes little
difference in these traumas. He couldn't recall a time when a
termination would have saved a mother's life.
SENATOR WIELECHOWSKI asked if he would agree that an ultrasound
scan for a pregnant woman is a medically necessary procedure.
DR. THORP said not necessarily.
SENATOR WIELECHOWSKI asked if he testifies in other states about
abortion issues.
DR. THORP said yes, and recalled that he was in Anchorage at
this time last year.
SENATOR WIELECHOWSKI asked if he testified in North Carolina
about a requirement for trans-vaginal ultrasounds for most
abortions.
DR. THORP said he didn't recall ever having testified in North
Carolina.
SENATOR WIELECHOWSKI asked if he attempted to intervene in a
lawsuit in North Carolina requiring ultrasounds for abortions.
DR. THORP said not that he recalled.
SENATOR WIELECHOWSKI asked if he made a statement saying, "In my
medical opinion, receiving an ultrasound scan and accompanying
descriptive information, as mandated by the Act, is essential
for a women's consent to be fully formed and voluntary."
DR. THORP said he didn't recall making that statement.
SENATOR WIELECHOWSKI asked if he agrees with that statement.
DR. THORP said he would need the context in order to agree or
disagree.
SENATOR WIELECHOWSKI asked if he would agree that providing
ultrasonic images and accompanying embryonic fetal developmental
information, particularly for a pregnant patient, is the
standard of care in obstetrics and gynecology.
DR. THORP said it's usually done.
SENATOR WIELECHOWSKI asked if he had ever made that statement.
DR. THORP said he didn't recall making it.
2:29:19 PM
SENATOR WIELECHOWSKI asked if an ultrasound is a medically
necessary procedure for a woman considering an abortion.
DR. THORP said it is a usual part of termination of pregnancy
care.
SENATOR WIELECHOWSKI asked if it is usual and customary
procedure in Alaska.
DR. THORP said he didn't know. He imagined there is a lot of
ultrasound done in Alaska like there is in other states.
2:30:01 PM
SENATOR WIELECHOWSKI asked if he believes that providing
counseling information to women considering undergoing abortion
is medically necessary.
DR. THORP said it is medically necessary and ethically
obligated.
SENATOR WIELECHOWSKI asked if it could potentially endanger a
woman's life if counseling is not provided to a woman
considering an abortion.
DR. THORP said he did not understand the question.
SENATOR WIELECHOWSKI asked if he believes that not providing
counseling to a woman considering abortion would potentially
endanger her life.
DR. THORP said there would be a small risk of endangerment to
her life and an ethical breach of her autonomy.
2:31:24 PM
SENATOR OLSON said the questions are less than specific and, as
a medical doctor, he wouldn't necessarily agree with the line of
questioning. He stressed that for any procedure, a physician
would have to provide information about the risks of such a
procedure. He agreed that there would have to be counseling of
some sort.
SENATOR WIELECHOWSKI asked if it is medically necessary to
counsel a woman about fetal pain that may occur.
DR. THORP said he didn't think doctors know enough about fetal
pain to provide much counseling.
CHAIR COGHILL said he was allowing the questions in order to
determine Senator Wielechowski's thinking about what is or is
not a medically necessary procedure.
SENATOR WIELECHOWSKI explained that he was trying to figure out
the line between what is medically necessary and what is not.
2:33:38 PM
DR. THORP asked Senator Wielechowski to define "medically
necessary."
SENATOR WIELECHOWSKI asked Dr. Thorp how he defines it.
DR. THORP clarified that he has tried to define conditions that
threaten the life or long-term physical health of the mother to
such an extent that the state should be obliged to fund a
termination of pregnancy procedure, should the mother choose
that. Other than that, "medically necessary" is vague. He
suggested that the bill states that physicians and patients can
do whatever they want, so there are probably some less-than-
life-threatening reasons why women are ending their pregnancies.
2:35:14 PM
SUSAN RUTHERFORD, MD., said she works as an OBGYN physician and
in 1990 started a program in maternal fetal medicine at
Evergreen Hospital. She explained that her primary role is as a
practicing maternal fetal medicine specialist. She reviewed her
medical credentials.
DR. RUTHERFORD said the bill is a good effort and helpful in
establishing medical necessity. She opined that most doctors
would generally agree about what is medically necessary. The
statistics quoted about the rarity of "medical necessity" are
valid, but it's mostly the patient's choice. She said patients
all come with a medical history and it's rare to see a patient
with a history of an abortion that was medically necessary. She
said she has only seen one person in 30 years who medically
required an abortion.
2:39:48 PM
DR. RUTHERFORD agreed with the list of conditions when a
medically necessary abortion is warranted. She suggested, from a
medical standpoint, that some of the items be reordered. Such
as, she would put epilepsy and seizures with convulsions. She
said she would add a maternal history of myocardial infarction
and gestational trophoblastic disease, an abnormal pregnancy
situation. She noted that kidney infections are common during
pregnancy, but shouldn't be on the list.
DR. RUTHERFORD addressed several subjects Dr. Thorp mentioned
during his presentation. Regarding trauma, she said that it is
unwise to add abortion to a patient who is unstable due to major
trauma. She opined that an ultrasound is absolutely indicated
prior to an abortion. A trans-vaginal ultrasound should be used
when a regular ultrasound does not work. She opined that fetal
abnormalities could be added to the list.
She noted that she does not perform pregnancy terminations.
2:42:57 PM
CHAIR COGHILL said he would take her suggestions seriously.
2:43:30 PM
SENATOR WIELECHOWSKI asked Dr. Rutherford if she wrote an
article that stated abortion is linked to an increase in risk of
breast cancer.
DR. RUTHERFORD said she didn't write any articles on breast
cancer, but she believes there is evidence to that effect. The
idea should not be summarily dismissed because that question has
not been answered yet.
SENATOR WIELECHOWSKI asked if she disagrees with the evidence
from the National Institute of Health and the National Cancer
Institute that state just the opposite.
DR. RUTHERFORD said she listened to Dr. Coleman's testimony and
agreed that there are flaws in medical literature, physician
statements by national organizations, and state laws. She stated
that she disagrees with the statement that there is no link
between abortion and breast cancer.
SENATOR OLSON asked if she agrees that somebody with a kidney
infection who is becoming septic needs to be treated.
DR. RUTHERFORD said yes; sepsis needs to be treated and someone
who is pregnant is more prone to pulmonary edema and acute
respiratory distress syndrome. She suggested adding to the list
sever infection, including sepsis, exacerbated by pregnancy.
SENATOR OLSON asked about adding disseminated intravascular
coagulopathy (DIC) related to eclampsia or preeclampsia.
DR. RUTHERFORD agreed that DIC could be added to the list.
2:48:28 PM
SENATOR DYSON asked Dr. Rutherford if she has dealt with any
pregnant women who had a terminal disease and opted not to
abort.
DR. RUTHERFORD said she recalled one instance, but noted there
are treatments for cancer during pregnancy. She suggested that
the items on the list be discussed with the patient for
consideration and should not automatically result in a
termination. There are exceptions to many of these situations,
such as those with epilepsy and treatable cancer. She said she
hasn't been personally involved with a pregnancy where the
mother has a terminal disease; it's extremely rare.
CHAIR COGHILL thanked the participants. He noted public
testimony would continue on Monday.
CHAIR COGHILL held SB 49 in committee.
2:51:46 PM
There being no further business to come before the committee,
Chair Coghill adjourned the Senate Judiciary Standing Committee
meeting at 2:51 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB0049B Sponsor Substitute.pdf |
SJUD 2/27/2013 1:30:00 PM SJUD 3/4/2013 1:30:00 PM SJUD 3/5/2013 1:30:00 PM SJUD 3/11/2013 5:00:00 PM |
SB 49 |
| Sponsor Statement - Medically Necessary.docx |
SJUD 2/27/2013 1:30:00 PM SJUD 3/5/2013 1:30:00 PM SJUD 3/11/2013 5:00:00 PM |
SB 49 SB 49 Sponsor Statement |
| Sectional SB 49.doc |
SJUD 2/27/2013 1:30:00 PM SJUD 3/4/2013 1:30:00 PM SJUD 3/5/2013 1:30:00 PM SJUD 3/11/2013 5:00:00 PM |
SB 49 |