Legislature(2001 - 2002)
03/16/2001 12:00 PM Senate HES
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SB 91-ABORTION: INFORMED CONSENT;INFORMATION
CHAIRWOMAN GREEN announced SB 91 to be up for consideration.
MS. SANDY ALTLAND, staff to Senator Ward, sponsor, explained that
SB 91 provides more information to people who are considering an
abortion. It asks the Department of Health to prepare a handbook
with the information that is needed. Some people have emotional
problems after a procedure and more information in the beginning
might help them.
MS. NANCY DAVIS, Acting Director, Division of Public Health, said
she was presenting the prepared testimony of Karen Pearson,
Director as follows:
The Division of Public Health supports what appears to
be the intent of this bill insuring that all women
seeking a abortion are fully informed prior to signing
consent for the procedure to be done. Since this is
currently required to any surgical procedure being
performed and is considered essential by the medical
provider and the advocate communities, we question the
need for a law specific to the abortion procedure.
I believe we are in agreement that each woman seeking
an abortion needs information about the physical,
emotional, psychological and medical risks and benefits
of the procedure them personally. This bill seeks to
address this need by requiring each women be provided a
detailed and lengthy informational document and
requiring that the provider have the patient sign a
form indicating she has read and understands the
information in the document and its relevance to her.
Some women would find such material information, but
many who are of low literacy, illiterate or for whom
English is a second language would not be served well
by this process. Many individuals who have reading
problems are very skilled at hiding those problems from
those with whom they interact. Thus, it could be very
difficult for a provider to ascertain surely or with
any degree of certainty that a woman to whom the
written materials were provided was actually able to
read and comprehend the information.
Providers are accustomed to explaining procedures,
risks, and benefits relative to medication options,
treatment options of all kinds and being able to follow
up on questions and concerns as they arise. They are
used to tailoring the information given to meet the
specific needs of the patient being seen. There are
many individual health issues that a physician must
address with each patient no matter what the procedure
that will be performed. These needs are not well served
when large volumes of written information that may or
may not be relevant to that individual are required
first in order to verify that a person is informed. The
language, culture, age and other relevant factors of
the woman must be considered when deciding how to
provide information in the most usable form and manner
and only the provider working with the patient can
determine those individual needs. There are substantial
costs as reflected in the fiscal note related to the
Department of Health and Social Services staff
compiling and keeping current lists of providers,
agencies and organizations in each community that
provides support, aid or other services for women
contemplating parenting, adoption or abortion. Local
communities are well-versed in local resources and are
better able to keep the information current at
significantly lower costs. Thus, if these booklets do
not significantly improve the process of informing the
patient, and we believe they will not, then this money
could perhaps be used to fund needed services or to
educate women about avoiding unintended pregnancies
and, thus, avoiding contemplating having an abortion.
TAPE 01-24, SIDE A
CHAIRWOMAN GREEN asked if they generally refer people to a
physician, if possible.
MS. DAVIS answered that the Public Health Division, through
several different divisions, encounters women who are pregnant or
seeking a pregnancy test. Through some of their grantees, that
encounter is made through public health nurses in public health
centers at the local level. They do not provide any abortion
services at public health centers or by public health staff. They
refer clients to whatever services they need or seek. She said
further that public health services are primarily preventive in
nature and for on-going prenatal care or other things, they refer
them to an on-going provider.
MS. IDA BARNICK, Alaskans for Life, Inc., supported SB 91. She
said, "Medical and scientific fact have proven that human life
begins at conception."
This is extremely important for a woman who is contemplating the
life of her unborn child to understand what she is doing.
Therefore, she deserves to know the age, the fetal
development of her unborn child, possible psychological
effects that she might experience if she ends the life
of this child and she needs to know what the other
options to abortion or other community services that
can help her if she decides to let her unborn child
live. She should never be coerced into having an
abortion. She should be required to sign a statement
that she was given the information…
MS. BARNICK said this is the same procedure she would have to go
through if she were going to have any other major or minor
medical procedure. If English is the second language, she would
usually have an interpreter with her who will explain the
information. She also didn't think it was unusual for a state
agency to have to provide brochures to the public for various
things and she didn't believe it would cost that much.
Number 460
MS. KAREN VOSBURGH, Executive Director, Alaska Right to Life,
said she didn't understand the opposition by pro-abortion forces
to allow women to have full and informed consent. She has found
that when women are considering abortion, very little factual
information is actually given. She said there are over 100
potential physical complications associated with abortion. She
presented some abortion statistics for Great Britain saying that
she new women were not aware of these. She said that many studies
have connected breast cancer and abortion and have also connected
it with the pill.
According to Calinborn (ph), based on the most
comprehensive medical evidence available, induced
abortion and the birth control pill are both
independent root factors for development of breast
cancer. This risk is especially great if the women have
participated in either of these factors at a young age…
She said that despite evidence of the dangers of breast cancer
from abortions and contraceptive use, "abortion clinics continue
to promote abortion on demand." She said that evidence of
psychological damage from having abortion is overwhelming.
Number 825
MR. BOB LYNN, President, Alaskans Right to Life, said that
passing a statute mandating informed consent is not about whether
abortion should or should not be legal or available or who should
pay for it. "My concern today is nothing more than a woman's
right to know the facts about any medical procedure including an
abortion procedure before consenting to it."
He said that informed consent is routine. If women knew some of
the risks of abortion, she might not consent. He noted that
abortion providers only get paid when a woman decides to abort.
MR. LYNN said that he sells real estate and that everyone who
sells a house must provide a disclosure statement to buyers.
Likewise, Alaska Right to Life thinks that anyone who
sells an abortion should provide the buyer of that
abortion with a full disclosure of facts. So there was
informed consent before the woman buys the abortion. I
hope the legislature thinks that the health of a woman
is more important than the health of a house.
DR. COLLEN MURHPY, Anchorage Obstetric Gynecologist, said she is
Board certified by the American College of OBGYN. She wanted to
reassure the audience and said:
The standard procedure for medical practice is to
provide informed consent. It currently constitutes
excellent patient care. It is currently required by all
professional organizations under all circumstances be
it for a medical or a surgical procedure of any nature.
Likewise, our professional ethical standards require it
and furthermore the lawyers demand it. I will say
repeatedly again and again, that this particular
attempt at informed consent is not required under state
law. This is something that is done in the privacy of
the office with an individual patient and client
talking about the serious nature of a condition be it
related to abortion, a hysterectomy, a colposcopy or a
gall bladder surgery. For the legislature to step in
between the privacy of a patient and a doctor is
inappropriate. We are practicing medicine and this does
not need to be legislated.
DR. MURPHY disagreed with the preceding scientific information by
someone describing breast cancer. That is not scientific fact and
is a subjective evaluation. She also wanted to discuss what they
could do about the tragedy of unintended pregnancy in Alaska.
Currently, 60 percent of pregnancies are unintended in
Alaska. It is estimated that half of those pregnancies
will go to termination of pregnancy. The other half may
miscarry or become live born. Some women will elect to
adopt them out. If we truly want to decrease the need
or the request for abortion, we should be directly our
attention towards decreasing the reasons unintended
pregnancy occurs in Alaska. Rather than fighting about
informed consent, which is something that is done
privately between a trained medical provider when a
surgical condition is being considered with a patient.
I would suggest that we direct our attention, just like
the World Health Organization has suggested elsewhere.
The best way to decrease the need for termination of
pregnancy is to increase the availability of
contraception. I would challenge this committee to look
at a bill that has currently been proposed by Senator
Johnny Ellis, SB 15, called the prescriptive fairness
act. This is a step in the right direction that is
concrete, that everyone can agree on - that women who
use contraception that is reliable and approved by the
FDA - have a lower risk of unintended pregnancy and the
need for termination.
DR. MURHPY said they should spend time doing something that they
know works rather than putting women and providers in additional
difficulties and expense based on the proposals in this bill.
CHAIRWOMAN GREEN said she had a question from someone who had to
leave earlier, but they refer to the term in the bill of
"gestational age", which is neither a medical nor scientific
concept and asked if there was better phrasing.
DR. MURPHY replied that gestational age varies. She explained:
There is something called Migel's Rule. It's when you
find out when the woman's last menstrual period is. You
add nine months plus one calendar week and it's the
estimated date of confinement. From that, we calculate
the supposed gestational age. The average pregnancy
will be approximately 40 weeks in duration. A normal
term pregnancy will deliver between 37 and 42 weeks. To
make a long story short, menstrual dating is
notoriously inaccurate. If you go ahead a
retrospectively date a pregnancy based on the baby's
size and weight and appearance at birth, 25 percent of
menstrual dates are inaccurate for gestational aged
dating. In modern obstetrics, we will often alter the
dating of the pregnancy based on ultrasonigraphic
findings in which we might go ahead and measure the
gestational sack size. We might measure the crown
growth points, the fetal fold, different measurements
of the skull or the femur length. This will alter the
gestational age such that we no longer rely on the last
menstrual period because a bleeding episode did not
occur exactly two weeks prior before the egg was
released from the ovary.
CHAIRWOMAN GREEN asked if the method of computing the gestational
age has been refined through time.
DR. MURPHY responded that it no longer relies on just the last
menstrual period. "It's invariably complemented with
ultrasonigraphic and physical exam."
CHAIRWOMAN GREEN asked if using those methods, was there a range
in which she could identify at what point of development the
unborn child is.
DR. MURHPY replied, "I don't know what an unborn child is. I'm
not familiar with the term unborn child. She is a physician and
medically trained and has never come across unborn child in my
medical training."
CHAIRWOMAN GREEN asked what phrase would she use for the before
delivery time.
DR. MURHPY said they don't use that phraseology. She explained:
When a fertilized egg divides, it changes into a
blastocyst and then it will implant into the uterus and
be called an embryo until eight weeks gestation. From
eight weeks gestation until the time of delivery, it is
called a fetus. There is no such thing as unborn child
in medical literature.
CHAIRWOMAN GREEN asked how she identified the number of weeks or
what the stage of development is. She asked, "If when you are
making those assumptions, are you basing that on a range of time
versus this is a specific day in the development versus it could
be within two weeks."
DR. MURHPY replied:
It gets pretty interesting. If you look at first
trimester, which according the American College of
OBGYN is up to 14 weeks in pregnancy, and then the
second trimester is 14 weeks to 28 weeks and third
trimester is 28 weeks to birth. Basically, we know if
we do ultrasound measurements of the fetus, that world
wide based on large statistical studies [indisc.] that
fetuses pretty much grow at a very similar rate in the
first trimester, through 14 weeks - such that you can
date the pregnancy within several days to about 10
days. Between 14 weeks [and 28 weeks] we start to get
such variation that it's two weeks difference. So,
we're not accurate. I think a lot of lay people give us
too much credit for being terribly accurate and we
really aren't. We guess pretty well.
Number 1486
MS. SHERRY GOLL, Alaska Pro Choice Alliance, Haines, said they
are a state wide coalition of diverse nonprofit organizations
with a mission of protecting reproductive rights and to promote
reproductive health services through education, advocacy and
community organizing. Although the group promoting this
legislation think it is informational, her organization thinks it
is trying to intimidate and harass women who are choosing to have
an abortion. She said:
Apparently, people are under the impression that women
take this kind of decision lightly instead of thinking
about it and dealing with it in the privacy of their
own lives, making their own constitutionally protected,
private pregnancy decision with their physician. As Dr.
Murphy just stated, physicians for all surgical
procedures provide informed consent. To suggest that
women in this particular instance have to be shown
photographs - I mean photographs of a developing fetus
would be more appropriate to show to a woman who is
planning to have a pregnancy and there are many books
in the library to help you understand child development
if you're going to have a baby.
If a man needs to have a cyst removed from his
testicles, do you think it would appropriate for the
legislature to put in law that this man should be shown
pictures of how that cyst would grow over a period of
time if he fails to remove it.
I think the bill is flawed in ways using terms that are
so charged, like unborn child, when as you know it is
not a medical term. If it's meant to be educational, if
you want to provide information, don't tell women that
the father of their child will be under obligation to
provide child support unless you're also going to tell
her what the statistics are that obligors pay their
child support. I am very much opposed to this
legislation. I think that it's just intended to harass
women who choose to have an abortion and it is clear
that it is that type of bill by the folks who have
shown up to testify on it. I appreciate your taking my
testimony. Thank you very much.
Number 1620
MS. ANNA FRANKS, Fairbanks, said she would be reading testimony
from Alicia Wells, Anchorage resident, who was home caring for
her children. The letter said preventing pregnancy sometimes is
just based on luck and that a woman can get pregnant using an
IUD. She said that she was never forced to have sex against her
will and that her parents shared with her information about
responsible sexual behavior. She read:
Not all women are that lucky, however, and for one
reason or another, many women find themselves pregnant
when they don't want to be. For these women, the
decision about what to do is not easy. I know from
having counseled several friends with this decision
that it is not one that any woman takes lightly. Women
who are in this situation need access to good quality
information and supportive non-judgmental counseling
about their actions.
She read further that:
SB 91 masquerades as something that will help women
make a decision at this critical time in their lives,
its main purpose is to intimidate women and make them
feel guilty for exercising their right to make choices
about their bodies and their lives. In addition to
being a blatant anti-choice attempt to restrict women's
rights, there are several major problems with the bill.
First, the legislature has no business telling doctors
the specifics of what they can and should be saying to
their patients. Doctors are already bound by the
standards of practice which include providing complete
and unbiased information and counseling about medical
procedures as well as insuring that a woman or any
patient freely consents to the procedure she will
undergo. These systems are already established and
working. There is not need for special information
consent forms just for abortion.
Second, the purposed intent of this so-called
counseling material is clearly biased and intended to
dissuade women.
Third, the proposed content of the so-called counseling
materials related to the psychological affects of
abortion is simply not supported by scientific
research.
Finally, SB 91 shows a lack of respect for women. It
assumes that women will not make the right choice
without an extra push in the right direction from the
state. Well, as a woman myself and someone who has
talked to many women, I can assure you that women do
have the ability to make thoughtful and moral decisions
about their lives. We need to respect that ability and
provide women with quality information and services so
that they may have the best possible outcome whatever
their choice. I urge you to vote against SB 91 and
allow women to make their own decisions with the
assistance and medical expertise of their own doctors.
MS. JENNIFER RUDINGER, Executive Director, Alaska Civil Liberties
Union (ACLU), opposed SB 91. She asked if the committee had
received testimony from Dr. Sharon Smith, Dr. Cathy Todd and Dr.
Jan Whitefield regarding this bill.
CHAIRWOMAN GREEN replied that they did receive it.
MS. RUDINGER summarized her testimony:
I want to first of all point out something that hasn't
been mentioned yet and that's that SB 91 requires that
the physician, him or herself, be the person delivering
these extraneous lectures to the patient. This is going
to have the effect of not only forcing doctors to give
information that may not be relevant to that particular
patient's circumstances, but also by using the doctor's
time to do this, is making access to quality health
care more difficult and more expensive. SB 91 will not
allow a trained counselor, a nurse or another health
care practitioner to provide the state's mandatory
lecture to the patient and there are very few doctors
already available. There's a shortage of doctors able
to help women in these circumstances. By taking the
doctors time and forcing them to deliver these lectures
when other healthcare practitioners could do it is
going to drive up the cost of healthcare and make
access more difficult.
Finally, I just want to address some of the medical
misinformation, actually, that's been put on the
record, to kind of correct the record. SB 91 refers to
possible psychological affects that have been
associated with having an abortion and as Dr. Murphy
testified, this is really substituting lay people and
politician's judgment for that of doctors. Practicing
medicine is something that should be left up to people
with a medical license. This reference to possible
psychological effects is misleading because no such
psychological harms have been proved to exist and in
fact to corroborate that, according to a 1987-88
investigation by former Surgeon General C. Everett
Coup, who is of course no champion of choice, as well
as another study by the World Health Organization,
there is no medical evidence that abortion causes
psychological injury. On the contrary, relief is the
most common reaction to a voluntary abortion whereas
women who are forced to continue unwanted pregnancies
suffer adverse and sometimes severe psychological
consequences. So, again this is where it should be left
to doctors to decide based on their best medical
judgment, based on the specifics of their patient, what
risks and benefits are relevant to that patient, what
medical information is scientifically sound.
And finally, I hadn't planned to discuss this, but I
must just briefly rebut the allegation that there's a
link shown between abortion and breast cancer. The
latest scare tactic initiated by anti-choice groups is
to link abortion with breast cancer. Ceasing upon scant
evidence in a 1994 research study, they have mounted a
bigger advertising and legislative campaigns to
convince the public that having an abortion increases a
woman's chance of contracting breast cancer. In fact,
this study they are referring to published in the
Journal of the National Cancer Institute reported a
small statistical connection between abortion and
breast cancer. Although cancer research experts have
characterized this study as inconclusive and
methodolically problematic, anti-choice activists
eagerly wield it as a new way to frighten women and
restrict their choices. Opponents of choice have
persuaded legislators in several states that there is
this link, that this is part of the information that
needs to be conveyed. It's not clear from this bill
whether, in fact, that's the case, but if anyone is
under the impression that there is such a link and that
this information is needed for informed consent, I'd
like to mention, and I can get this for you later, a
couple points that illustrate just the opposite. The
Natural Cancer Institute has charged that the study has
been interpreted inaccurately and, "There is no
evidence of a direct relationship between breast cancer
and either induced or spontaneous abortion."
Second, the American Cancer Society has concluded, "The
inconsistencies of existing research do not permit
definitive scientific conclusions."
Third, on the day this study was published, the Journal
of National Cancer Institute, the source of the study,
printed an editorial stating that, "The overall results
of the study as well as the particulars are far from
conclusive and it's difficult to see how they will be
informative to the public.
The study was particularly criticized because of the
methodological problem of possible inaccurate reporting
of a history of abortion by participants.
Fourth, four recent reviews published in scientific
journals have assessed more than 30 studies and
concluded that the available data on the relationship
between induced or spontaneous abortion in breast
cancer are inconclusive. Fifth, a 1995 article in
Cancer Causes and Controls reported in an article
entitled Abortion and Breast Cancer Causes in Seven
Countries the study of these countries concluded, "In
Summary, these data suggest that any overall relation
between abortion and risk of breast cancer is likely to
be weak at the most."
This list goes on and on and finally, one more point, a
widely noted 1997 study of more than 1.5 million women
in Denmark where abortion histories are corroborated by
a government sponsored medical registry, so there's no
chance of reporting bias, concluded that, "Induced
abortions have no overall affect on the risk of breast
cancer."
In a New England Journal of Medicine editorial, a
company in the Danish research I just quoted, Dr.
Patricia Harkey (ph) of the National Cancer Institute
said, "It provides important new evidence to resolve a
controversy that previous investigations have been
unable to settle." In short, a woman need not worry
about the risk of breast cancer when facing the
difficult decision of whether to terminate a pregnancy.
MS. GOLL said she appreciated the opportunity to read these
articles into the record and offered to provide them with further
information they might find helpful.
MS. DIETRICK SITLER, Anchorage resident, opposed SB 91. She
wanted to share with them why a bill like this could be very
detrimental to many women like her as follows:
At the age of 14 I was diagnosed with hemophilia, a
disease affecting the blood. As a result of this
condition, it is medically dangerous for me to carry a
pregnancy to term, because the loss of blood during
delivery could be potentially fatal to me. I am in a
long-term committed relationship and my partner and I
are very careful, but as you know, no form of birth
control is 100 percent effective. Were I to become
accidentally pregnant, it would be in my best medical
interests to terminate the pregnancy rather than carry
the pregnancy to term. I strongly feel this is a
decision between my partner and I with the advice and
consultation of my doctor. The government I feel has no
place in this personal painful choice that I would have
to make. Furthermore, my partner and I would find it
very painful to have to listen to a litany of
alternatives to abortion - alternatives that are not in
our best interest and that could actually threaten my
life before we would be deemed capable of consenting to
an abortion.
My greatest objection is in your definition of a
medical emergency. I would not fall under the medical
necessity exception to SB 91, because having the
abortion at that very moment would probably not be a
life saving measure or an emergency situation.
Therefore, I would be subject to this extra counseling
which would be wholly irrelevant in my individual
circumstances. I have also heard a lot of testimony
today stating that if many women knew more facts about
abortion, they would probably choose not to have this
procedure. This is not entirely true, especially in my
situation. Not every woman that is having an abortion
is having this procedure just because they do not want
to have the child. What about women like me? There is
no exception for women like me. I would remind you that
this decision would already be very painful for me and
I would be terminating this pregnancy to save my own
life. Why should these extra hurdles be placed on me,
especially when they are not placed before any other
patient seeking any other medical treatment. We urge
you to oppose this bill and thank you very much for
your time.
Number 2224
MS. MARY DYE, citizen of Alaska, supported SB 91 and read a
definition of informed consent that she got off the Internet:
In medicine a patient's written consent to a surgical
or medical procedure or other course of treatment given
after the physician has told the patient all of the
potential benefits, risks and alternatives involved.
She used an analogy of deciding whether or not to put gutters on
her home and gathering all the information available and deciding
if it was the thing to do. She said they could offer the
information to women and do the best you can.
MR. SID HEIDERSDORF, Juneau resident, supported SB 91.
TAPE 01-24, SIDE B
He said that informed consent is needed to protect women from
unscrupulous abortion practices. He pointed out this bill does
not attempt to outlaw abortion or place restrictions on a woman's
right to an abortion. He said, "Abortion is not an honorable or
an innocent medical procedure and those who are involved with it
are not likely to be very open and free about the information
when they are talking to their patient."
MR. HEIDERSDORF asked, "Why is abortion the only invasive medical
procedure for which full information is not given? It is well
known that abortion counseling is a sham."
Further he said:
If biased information results in an attitude of viewing
it as being anti abortion, I think there's something
there to look at. The fact is that scientific unbiased
information, which is required by this legislation, may
in fact speak against abortion and that's the way it
is. It's true if the child in the womb, which is the
crux of the issue, is what's discussed. That's what
women really must know.
We hear a lot said about RU486. In August of this past
year, Serle, the company that produces one of the drugs
used in the RU486 abortion procedure, wrote a letter to
200,000 medical practitioners in this country telling
them, "Don't use cytotech for abortions." They said
don't use it because it's dangerous. They didn't study
it for that purpose; this is a drug used to cure
ulcers, not to be used for producing contractions for a
woman to expel a dead baby.
He passed out an article to the committee on cytotech in which a
woman died who used it. He disagreed that there wasn't a link
between abortion and breast cancer. He said there are over two
dozen scientific articles that do show a strong link between
abortion and breast cancer, especially first pregnancy abortions.
He said, "The evidence is building."
Specifically, SB 91 does not include a waiting period. He thought
a 24-hour waiting period was critical because a woman needs to
get the information and get away from the doctor and the clinic
personnel, because they are out to sell an abortion. "They are in
the business of selling these abortions."
One final thing was on page 5, line 3. He was concerned that this
language did not require that the woman be given the information
produced by the Department of Health and Social Services.
CHAIRWOMAN GREEN said she thought page 5, line 8, addressed his
concern.
MR. HEIDERSDORF responded that he was concerned with language in
AS 18.05.032.
Number 1853
MS. MARY HORTON, Juneau resident, supported SB 91, because of a
recent experience she had bringing healing to two men and six
women who had experienced abortion in Juneau. Their ages were 17
- over 50 years. She said that a man begins to deal with an
abortion 5 - 7 years after it's happened. She said, "When we talk
about the abortion, it's not only the woman who carries the
child, the fetus, it's also the grandparents, the sisters and
brothers that come before or are still there, the man who
fathered the child."
She said there will be another opportunity for healing that is
called Project Rachael, Rachael's Vineyard. In her experience,
she found that women were very surprised to hear the other side
of the story, that men were carrying the guilt and what could
they have done about it. "Women need to know, but so do the men…"
She said that people who can't read can see pictures and can
understand clearly what's going on. It's hard for her to express
all the healing that happened and SB 91 would go a long way in
helping people think about it a little bit more clearly.
CHAIRWOMAN GREEN said she was chagrined at some of the comments.
She had undergone various surgeries and had seen pictures of body
parts on the doctor's office wall and what might be wrong with
them and how they could be corrected. She received a great deal
of information and the consent forms and waivers she signed were
all inclusive. She continues:
On the other hand, I would say that those who say that
government should not be involved in this decision
making and certainly in regulating and/or prohibiting
or allowing are the very same people who spend a great
deal of time challenging the fact that state Medicaid
money should indeed be used to fund abortions. So, I'm
a little conflicted on those.
SENATOR DAVIS asked if there would be time for more public
testimony.
SENATOR WARD said he had a lot of people who wanted to testify
and wanted to know if any state money had been spent on
psychological follow-ups or abortions; if so, how much. He was
trying to figure out if the state is liable.
CHAIRWOMAN GREEN adjourned the meeting at 2:55 p.m.
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