Legislature(1997 - 1998)

03/31/1998 03:08 PM House HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
         HOUSE HEALTH, EDUCATION AND SOCIAL                                    
            SERVICES STANDING COMMITTEE                                        
                   March 31, 1998                                              
                     3:08 p.m.                                                 
MEMBERS PRESENT                                                                
Representative Con Bunde, Chairman                                             
Representative Joe Green, Vice Chairman                                        
Representative Brian Porter                                                    
Representative Fred Dyson                                                      
Representative J. Allen Kemplen                                                
Representative Tom Brice                                                       
MEMBERS ABSENT                                                                 
Representative Al Vezey                                                        
COMMITTEE CALENDAR                                                             
CONFIRMATION HEARINGS:                                                         
Board of Education                                                             
     Bettye Davis - Anchorage                                                  
     Mike Williams - Akiak                                                     
     - CONFIRMATIONS ADVANCED                                                  
Alaska Mental Health Trust Authority Board of Trustees                         
     Susan LaBelle, MSW - Anchorage                                            
     - CONFIRMATION ADVANCED                                                   
Professional Teaching Practices Commission                                     
     Georgia S. Cast - Bethel                                                  
     Patricia E. Chitty - Nikolaevsk                                           
     Linda Connelly - Palmer                                                   
     Judith Entwife - Juneau                                                   
     - CONFIRMATIONS ADVANCED                                                  
State Commission for Human Rights                                              
     Christine R. Marasigan - Anchorage                                        
     James H. Chase - Anchorage                                                
     - CONFIRMATIONS ADVANCED                                                  
* HOUSE BILL NO. 270                                                           
"An Act relating to premarital relationship counseling; amending               
Rule 9(e)(7), Administrative Rules of Court."                                  
     - HEARD AND HELD                                                          
* SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 372                                    
"An Act placing limits on prescribing and providing a contraceptive            
drug or device to a minor."                                                    
     - HEARD AND HELD                                                          
* HOUSE BILL NO. 420                                                           
"An Act requiring that health care insurers offer certain coverage             
for treatment of diabetes."                                                    
     - SCHEDULED BUT NOT HEARD                                                 
* HOUSE JOINT RESOLUTION NO. 58                                                
Proposing amendments to the Constitution of the State of Alaska                
relating to the education fund.                                                
     - SCHEDULED BUT NOT HEARD                                                 
(* First public hearing)                                                       
PREVIOUS ACTION                                                                
BILL: HB 270                                                                   
SHORT TITLE: REQUIRED PREMARITAL COUNSELING                                    
SPONSOR(S): REPRESENTATIVES(S) KEMPLEN                                         
Jrn-Date    Jrn-Page           Action                                          
 5/02/97      1467     (H)  READ THE FIRST TIME - REFERRAL(S)                  
 5/02/97      1467     (H)  HES, JUDICIARY                                     
 3/31/98               (H)  HES AT  3:00 PM CAPITOL 106                        
BILL: HB 372                                                                   
SPONSOR(S): REPRESENTATIVES(S) DYSON                                           
Jrn-Date    Jrn-Page           Action                                          
 1/30/98      2182     (H)  READ THE FIRST TIME - REFERRAL(S)                  
 1/30/98      2182     (H)  HES, JUDICIARY                                     
 3/18/98      2647     (H)  SPONSOR SUBSTITUTE                                 
 3/18/98      2647     (H)  READ THE FIRST TIME - REFERRAL(S)                  
 3/18/98      2647     (H)  HES, JUDICIARY                                     
 3/31/98               (H)  HES AT  3:00 PM CAPITOL 106                        
WITNESS REGISTER                                                               
AL ZANGRI, Chief                                                               
Bureau of Vital Statistics                                                     
Department of Health and Social Services                                       
P.O. Box 110675                                                                
Juneau, Alaska  99811-0675                                                     
Telephone:  (907) 465-3392                                                     
POSITION STATEMENT:  Testified in support on HB 270 as amended.                
LISA TORKELSON, Legislative Assistant                                          
   to Representative Fred Dyson                                                
Alaska State Legislature                                                       
Capitol Building, Room 428                                                     
Juneau, Alaska  99801-1182                                                     
Telephone:  (907) 465-3467                                                     
POSITION STATEMENT:  Testified on SSHB 372.                                    
CYNTHIA BROOKE, M.D., Representative                                           
American College of Obstetricians and Gynecologists                            
3340 Providence Drive, Number 454                                              
Anchorage, Alaska  99508                                                       
Telephone:  (907) 563-8588                                                     
POSITION STATEMENT:  Testified in opposition to SSHB 372.                      
JANE CONARD                                                                    
P.O. Box 2042                                                                  
Bethel, Alaska  99559                                                          
Telephone:  (907) 543-3629                                                     
POSITION STATEMENT:  Testified in opposition to SSHB 372.                      
JENNIFER SCHMIDT                                                               
P.O. Box 82944                                                                 
Fairbanks, Alaska  99708                                                       
Telephone:  (907) 457-2312                                                     
POSITION STATEMENT:  Testified in opposition to SSHB 372.                      
NANCY ROLLINS                                                                  
P.O. Box 1492                                                                  
Soldotna, Alaska  99669                                                        
Telephone:  (907) 262-2622                                                     
POSITION STATEMENT:  Testified in opposition to SSHB 372.                      
ANGELA MOEHRING                                                                
49301B Palmer-Wasilla Highway                                                  
Wasilla, Alaska  99654                                                         
Telephone:  (907) 357-5559                                                     
POSITION STATEMENT:  Testified on SSHB 372.                                    
JO CAMPBELL                                                                    
3701 Amalga Street                                                             
Juneau, Alaska  99801                                                          
Telephone:  (907) 789-2080                                                     
POSITION STATEMENT:  Testified in opposition to SSHB 372.                      
PATRICIA MARK, Representative                                                  
Anchorage American Civil Liberties Union                                       
419 Barrow Street                                                              
Anchorage, Alaska  99507                                                       
Telephone:  (907) 495-0044                                                     
POSITION STATEMENT:  Testified on SSHB 372.                                    
CYNTHIA MOEHRING                                                               
4930B Palmer Wasilla Highway                                                   
Wasilla, Alaska  99654                                                         
Telephone:  (907) 373-5559                                                     
POSITION STATEMENT:  Testified on SSHB 372.                                    
KAREN PEARSON, Health Programs Manager                                         
Division of Public Health                                                      
Department of Health and Social Services                                       
P.O. Box 110610                                                                
Juneau, Alaska 99811-0610                                                      
Telephone:  (907) 465-3090                                                     
POSITION STATEMENT:  Testified on SSHB 372.                                    
ROBIN SMITH                                                                    
14100 Jarvi                                                                    
Anchorage, Alaska  99515                                                       
Telephone:  (907) 345-4407                                                     
POSITION STATEMENT:  Testified on SSHB 372.                                    
ANDREA ELLENSON                                                                
P.O. Box 877276                                                                
Wasilla, Alaska  99687                                                         
Telephone:  (907) 376-2206                                                     
POSITION STATEMENT:  Testified on SSHB 372.                                    
PETER NAKAMURA, M.D., MPH, Director                                            
Division of Public Health                                                      
Department of Health and Social Services                                       
P.O. Box 110610                                                                
Juneau, Alaska  99811-0610                                                     
Telephone:  (907) 465-3090                                                     
POSITION STATEMENT:  Testified on SSHB 372.                                    
LANA HENLEY                                                                    
P.O. Box 3136                                                                  
Palmer, Alaska  99645                                                          
Telephone:  (907) 746-1327                                                     
POSITION STATEMENT:  Testified on SSHB 372.                                    
RON KREHER, Program Policy Analyst                                             
Division of Public Assistance                                                  
Department of Health and Social Services                                       
P.O. Box 110640                                                                
Juneau, Alaska  99811-0640                                                     
Telephone:  (907) 465-2680                                                     
POSITION STATEMENT:  Testified on SSHB 372.                                    
BECCA BROWN                                                                    
536 Park Street                                                                
Juneau, Alaska  99801                                                          
Telephone:  (907) 586-1448                                                     
POSITION STATEMENT:  Testified on SSHB 372.                                    
ACTION NARRATIVE                                                               
TAPE 98-35, SIDE A                                                             
Number 0001                                                                    
CHAIRMAN CON BUNDE called the House Health, Education and Social               
Services Standing Committee meeting to order at 3:08 p.m.  Members             
present at the call to order were Representatives Bunde, Green,                
Porter and Kemplen.  Representatives Dyson and Brice arrived while             
the meeting was in progress.  Representative Vezey was absent.                 
Number 0115                                                                    
CHAIRMAN BUNDE announced the first order of business to come before            
the committee was confirmation hearings.  Committee members had a              
packet containing background information and recommendations for               
each of the nominees; resumes of the nominees had been previously              
distributed to committee members for their review.  He announced               
the committee would review the recommendations and forward them to             
the full session of the House of Representatives.  It does not                 
reflect the intent of any committee member to vote for or against              
an individual in further legislative sessions for the purpose of               
Board of Education                                                             
Number 0232                                                                    
REPRESENTATIVE JOE GREEN made a motion to advance the slate of                 
nominees for the Board of Education.  There being no objection, the            
confirmations of Bettye Davis and Mike Williams were advanced from             
the House Health, Education and Social Services Standing Committee.            
Alaska Mental Health Trust Authority Board of Trustees                         
Number 0285                                                                    
REPRESENTATIVE BRIAN PORTER made a motion to advance the name of               
Susan LaBelle for the Alaska Mental Health Trust Authority Board of            
Trustees.  There being no objection, the confirmation of Susan                 
LaBelle was advanced from the House Health, Education and Social               
Services Standing Committee.                                                   
Professional Teaching Practices Commission                                     
Number 0313                                                                    
REPRESENTATIVE FRED DYSON made a motion to advance the slate of                
nominees for the Professional Teaching Practices Commission.  There            
being no objection, the confirmations of Georgia S. Cast, Patricia             
E. Chitty, Linda Connelly and Judith Entwife were advanced from the            
House Health, Education and Social Services Standing Committee.                
State Commission for Human Rights                                              
REPRESENTATIVE J. ALAN KEMPLEN made a motion to advance the slate              
of nominees for the State Commission for Human Rights.  There being            
no objection, the confirmations of Christine R. Marasigan and James            
H. Chase were advanced from the House Health, Education and Social             
Services Standing Committee.                                                   
HB 270 - REQUIRED PREMARITAL COUNSELING                                        
Number 0453                                                                    
CHAIRMAN BUNDE announced the committee would next hear HB 270, "An             
Act relating to premarital relationship counseling; amending                   
Rule 9(e)(7), Administrative Rules of Court."  He asked                        
Representative Kemplen to introduce his bill.                                  
Number 0478                                                                    
REPRESENTATIVE KEMPLEN said HB 270 is an attempt to address one of             
the fundamental problems of society in terms of broken families and            
it provides an economic incentive for people contemplating holy                
matrimony to engage in premarital counseling.  He directed the                 
committee's attention to the background information in committee               
packets; specifically, the study, "Predicting Marital Satisfaction             
Using PREPARE: A Replication Study" showing a correlation between              
premarital counseling and the success of the marriage. An excerpt              
from Policy Review indicates that of the 100,000 couples per year              
that complete PREPARE, a premarital inventory developed by Lutheran            
psychologist David Olson, a questionnaire can predict with 85                  
percent accuracy who will divorce.  It's a good indicator of                   
whether or not two people who are contemplating the marriage                   
commitment are compatible.  It allows the couple to discuss key                
issues and to determine how to address those key issues during                 
their relationship.                                                            
REPRESENTATIVE KEMPLEN explained HB 270 is fairly simple and it                
establishes an incentive for marriage applicants in Alaska to                  
attend a minimum of four hours of relationship counseling.  The                
marriage license fee for couples attending the counseling is $25               
and $300 for couples who have not met the minimum of four hours                
counseling.  He explained HB 270 does not mandate the counseling;              
it provides an economic incentive for couples to participate in                
relationship counseling prior to marriage.                                     
Number 0701                                                                    
CHAIRMAN BUNDE wondered if the $300 fee would discourage marriage              
for people in lower income levels in some areas of the state.                  
REPRESENTATIVE KEMPLEN believes it would serve as an incentive for             
couples to attend the premarital counseling.                                   
CHAIRMAN BUNDE asked what the anticipated cost was for the                     
premarital counseling.                                                         
REPRESENTATIVE KEMPLEN said counseling done through a social worker            
is anticipated to cost about $275, whereas if counseling is done               
through a tribal elder or through a church, it would be easier and             
less expensive.                                                                
Number 0755                                                                    
REPRESENTATIVE GREEN confirmed, "So if I know a couple who decides             
they don't want the counseling, their fee is $300 and they can go              
ahead and do their thing.  If they want to save some bucks and they            
go to a minister who has sent off two boxtops and a $20 bill and               
he's considered a minister by four people that go to his church,               
does that negate the $275?"                                                    
Number 0890                                                                    
REPRESENTATIVE KEMPLEN said it was a possibility based on the                  
definition of "counselor" in subsection (d) of HB 270.                         
Number 0830                                                                    
REPRESENTATIVE GREEN expressed concern this may be kind of a                   
"limited entry to a license to steal" in that several years ago                
ministers were declared nonprofit so they didn't have to pay the               
tax rate, and suddenly everyone was sending away for certificates              
declaring them to be a minister.  His concern was that HB 270 would            
set up a situation whereby these "ministers" would advertise their             
services as a way for people to save $275.                                     
Number 0890                                                                    
REPRESENTATIVE KEMPLEN noted he had an amendment he would like to              
introduce at some point.                                                       
Number 0920                                                                    
REPRESENTATIVE TOM BRICE made a motion to adopt Amendment 1 which              
     Page 1, line 5, following (b)                                             
          Delete all through line 9                                            
          Insert "A surcharge of $275.00 shall apply to                        
          the fee for all marriage license applications                        
          unless the applicants submit acceptable                              
          evidence of having received at least 4 hours                         
          of relationship counseling.  Acceptable                              
          evidence of such counseling shall be a                               
          certificate attesting under oath or                                  
          affirmation of the counselor and the parties                         
          that the parties have completed at least 4                           
          hours of relationship counseling in the six                          
          months immediately preceding application for a                       
          marriage license."                                                   
CHAIRMAN BUNDE objected for discussion purposes.                               
REPRESENTATIVE KEMPLEN explained the department had expressed                  
concern with getting locked into a $25 fee in statute and                      
Amendment 1 allows the flexibility to change the fee without having            
to introduce legislation.                                                      
REPRESENTATIVE GREEN asked if it was Representative Kemplen's                  
intention that the remaining language in (b), as it exists, would              
follow the language in Amendment 1.                                            
REPRESENTATIVE KEMPLEN pointed out the language in (b) is replaced             
by Amendment 1.                                                                
CHAIRMAN BUNDE removed his objection and asked if there was further            
objection to Amendment 1.  Hearing none, Amendment 1 was adopted.              
CHAIRMAN BUNDE asked Al Zangri to come before the committee to                 
present his remarks at this time.                                              
Number 1000                                                                    
AL ZANGRI, Chief, Bureau of Vital Statistics, Department of Health             
and Social Services, testified in support of HB 270 as amended.  It            
is the department's belief that some revenue can actually be                   
generated from this legislation and is attempting to find                      
additional studies and literature that discuss the effect of this              
legislation.  In response to Representative Green's question                   
regarding the impact and effectiveness of this legislation as                  
written, individuals will certainly be able to get around it;                  
however, in order for that to happen someone will have to commit               
fraud certifying the 4 hours of counseling have been fulfilled.  On            
the other hand, he believed counseling sessions from a minister                
would be of great help to individuals before making a commitment.              
He pointed out that most of the ministers in Juneau require a                  
counseling session of at least a full day prior to performing a                
Number 1000                                                                    
REPRESENTATIVE GREEN asked if the department has found in its                  
statistical review there are in fact, charlatans claiming to be                
MR. ZANGRI said he was certain those situations do exist, but the              
department has no way of knowing how many exist because there is no            
licensing provision.                                                           
CHAIRMAN BUNDE said, "I would guess there wouldn't be any financial            
gain there if it was just somebody that wanted to fight the state              
or the system, but if you can get free counseling or very                      
inexpensive counseling from a legitimate - I use the word (indisc.)            
ministers ...."                                                                
REPRESENTATIVE GREEN said he was in favor of the counseling                    
session; he believed that too many people rush into marriage and               
don't consider certain things.                                                 
CHAIRMAN BUNDE asked if there were further questions or additional             
testimony on HB 270.                                                           
Number 1178                                                                    
REPRESENTATIVE FRED DYSON asked if Representative Kemplen had had              
any discussions with Representative Kelly regarding his covenant               
marriage bill and how these two pieces of legislation might fit                
REPRESENTATIVE KEMPLEN said he has not had discussions with                    
Representative Kelly but he has reviewed Representative Kelly's                
bill and he believes the two pieces of legislation actually                    
compliment each other.  He added the only impact would be in terms             
of the fiscal note; if Representative Kelly's legislation passes,              
the fiscal note for HB 270 would be moot because the department's              
computer system would need to be modified only once.                           
REPRESENTATIVE GREEN understood Representative Kelly's legislation             
was voluntary, whereas HB 270 was compulsory.                                  
Number 1244                                                                    
MR. ZANGRI explained that in terms of the fiscal note, if both                 
pieces of legislation pass this session, the department would need             
to change their forms and computer program only once.                          
CHAIRMAN BUNDE noted this was the first hearing for HB 270 and it              
would be held in committee for further consideration.                          
SSHB 372 - LIMITS ON CONTRACEPTIVES TO MINORS                                  
Number 1268                                                                    
CHAIRMAN BUNDE announced the next bill to come before the committee            
was HB 372, "An Act placing limits on prescribing and providing a              
contraceptive drug or device to a minor."  He requested that                   
Representative Dyson present his bill at this time.                            
Number 1330                                                                    
REPRESENTATIVE DYSON said he had been contacted by the parents of              
a teenage daughter who were outraged to find out their daughter had            
been provided prescription contraception without the parent's                  
knowledge and without the prescriber doing an adequate job of                  
checking the child's and family's medical records and history.                 
Faced with the deadline of submitting personal bills, he had                   
drafted a bill that contained a provision requiring parental                   
consent; however, after the judge's decision striking down parental            
consent on abortions, he surmised the parental consent provision               
wouldn't withstand a court challenge, so he redrafted the                      
legislation so it now requires the medical prescriber to check the             
patient's and family's medical history to avoid medical risk and to            
notify the parents.  He stated his belief that this will withstand             
a court challenge.                                                             
REPRESENTATIVE DYSON said subsequent to that, he had been in                   
contact with U.S. Congressmen Istook and Manzullo and Congressman              
Istook was outraged to find out that the 13-year-old daughter of               
one of his constituents was taken to a local clinic by her 37-year-            
old teacher and was given a shot of depoprovera.  The whole                    
situation outraged the parents which has caused them to go forward             
on the federal level with similar legislation.  He also has been               
talking with professionals in the medical field and has learned                
there is a series of medical conditions for which some of the                  
prescription contraceptions are counter-indicated; in particular,              
there are a number of things heart related and stroke related.  He             
said the committee would be hearing testimony from a parent whose              
child had been put in significant danger as a result of the                    
prescription of a contraception without knowing the family's                   
significant risk for permanent heart damage.  He offered to answer             
any questions.                                                                 
Number 1493                                                                    
LISA TORKELSON, Legislative Assistant to Representative Fred Dyson,            
Alaska State Legislature, clarified that it was the daughter of a              
constituent of Representative Manzullo who was taken to the clinic             
by her teacher.                                                                
CHAIRMAN BUNDE said, "It sounds like perhaps two issues here; one              
of medical malpractice and the other of access to parent's control             
- perhaps access."                                                             
REPRESENTATIVE DYSON pointed out HB 372 requires parental                      
notification, not parental control or consent.  It's his                       
understanding that here in Alaska, very young girls are becoming               
pregnant by males who are averaging 7 1/2 to 8 1/2 years older,                
which from his perspective as a father, speaks of exploitative                 
relationships.  He commented the entire system of statutory rape               
laws is set up on the inordinate amount of pressure males, in                  
particular, can put on young women to exploit them.  The goal is to            
do the best, under existing law and court interpretations, to make             
sure the medical risk is minimized and the parents are in the                  
information loop regarding their children.                                     
Number 1575                                                                    
REPRESENTATIVE PORTER said, "Just so the record is not ambiguous on            
the point that the behavior described by the sponsor reminds me of             
felonious criminal behavior, which it is, so ...."                             
CHAIRMAN BUNDE commented 13 and 7 1/2 certainly should be statutory            
REPRESENTATIVE DYSON interjected, "Which is not often prosecuted in            
our jurisdiction."                                                             
CHAIRMAN BUNDE announced he would begin taking public testimony at             
this time.  He asked Cynthia Brooke to present her comments.                   
Number 1600                                                                    
CYNTHIA BROOKE, M.D., Representative, American College of                      
Obstetricians and Gynecologists (ACOG), testified via                          
teleconference from Anchorage.  She explained that ACOG is a                   
national organization of Board Certified OB/GYN physicians which is            
a specialty dealing with women's health.  Many local ACOG                      
physicians are concerned about recent bills which they feel will               
have a negative impact on Alaskan women.  ACOG is especially                   
concerned by Representative Dyson's bill, SSHB 372.  She said                  
contraceptives save lives.  A healthy nonsmoking female who carries            
a pregnancy to full term is six times more likely to die than if               
she used oral contraceptives.  And this is just the beginning of               
the story.  Oral contraceptives alone save this country millions of            
health care dollars every year.  Some people feel this figure is               
conservative and may extend into the billions of dollars.  It does             
this by preventing about 130,000 hospitalizations annually.  This              
includes hospitalization for women with breast disease, ovarian                
cysts, anemia, pelvic inflammatory disease and other sexually                  
transmitted diseases, ectopic pregnancy, rheumatoid arthritis, and             
uterine and ovarian cancer.  In addition to the prevention of death            
and severe illness from unwanted pregnancies, oral contraceptives              
also have a profound beneficial effect on many diseases in women,              
including a 50 percent reduction in uterine and ovarian cancer.                
DR. BROOKE continued that SSHB 372 as amended, would now require               
parental notification of oral contraceptives for minors.  The ACOG             
believes that teenagers will not want to go to physicians  to                  
request contraceptives if their parents will be notified.                      
Teenagers frequently will not admit sexual activity to their                   
parents, the result would be decreased access to teenagers of                  
contraceptives and sexually transmitted disease counseling.  In                
light of the medical benefits of oral contraceptives, it seems this            
bill would discriminate on the basis of age; minors would not have             
access to the same health care benefits that older women enjoy.                
Beyond this, the logic of this bill is not apparent in light of                
current knowledge regarding teenage pregnancy.  Multiple studies               
have shown that teenage sexual activity is not affected by                     
availability of contraception.  Rather, the most successful                    
deterrent to teenage sexual activity is parental openness to                   
discussion of sexual issues with their teenagers.                              
DR. BROOKE stated a recent USA Today article summarized studies                
from the Center for Disease Control which showed a link between                
teenagers who delay their first sexual encounter beyond 20 years of            
age with educational level of their parents.  Whether or not a                 
teenager will have intercourse is determined by an internal moral              
compass which is most profoundly influenced by his or her parents,             
personal goals and sense of self-esteem.  Teenage pregnancy in this            
country costs $37 billion annually.  This is because teenage                   
mothers are significantly less likely to receive a high school                 
diploma, adolescent fathers finish fewer years of schooling and                
earn less income annually by age 27, children of adolescents are               
more likely to have health and cognitive disadvantages and to be               
neglected or abused, the daughters of adolescents are more likely              
to become adolescent mothers themselves, and the sons of                       
adolescents are more likely to be incarcerated.  She concluded on              
the basis of this information, the position of ACOG is that                    
limiting access of contraceptives to teenagers would increase                  
health care costs significantly and would have a negative impact on            
Number 1780                                                                    
CHAIRMAN BUNDE noted that Representative Dyson had mentioned cases             
of young women being prescribed birth control without a full                   
knowledge of their medical history.  He asked Dr. Brooke if that               
was standard medical practice.                                                 
DR. BROOKE responded it is not a standard medical practice and in              
her experience, she is not aware of any instances where that has               
happened.  People coming into her office to receive contraceptives             
are given a full history physical, but she can't speak to what                 
happens in other places.                                                       
CHAIRMAN BUNDE inquired if a doctor were to prescribe                          
contraceptives to a 14-year-old girl, would the doctor be totally              
dependent on the minor for the medical history or would the doctor             
have to request a more detailed medical history from the parents.              
DR. BROOKE said the doctor would be dependent on the minor in terms            
of the medical history.  Overall, teenagers are better off on oral             
contraceptives than off them; women are at decreased risk for                  
diseases in general on oral contraceptives than off them.                      
Number 1860                                                                    
REPRESENTATIVE GREEN referred to Dr. Brooke's remarks that the                 
availability of contraceptives doesn't necessarily have any effect             
on promiscuity of teens and asked if Dr. Brooke had discussed with             
her peers that HB 372 would deter teens from perhaps seeking                   
contraceptives that might otherwise prevent pregnancies or does it             
work in reverse.                                                               
DR. BROOKE stated in her opinion the requirement for parental                  
permission would deter teenagers from getting contraception.                   
CHAIRMAN BUNDE thanked Dr. Brooke for her comments and asked Jane              
Conard to present her testimony at this time.                                  
Number 1895                                                                    
JANE CONARD testified via teleconference from Bethel on behalf of              
her teenagers and as a registered nurse.  She said her concern with            
HB 372 is multiple and she highly applauds Dr. Brooke.  The                    
problems with a pregnant teen with a heart condition are much worse            
than a teen not pregnant with a heart condition.  She has discussed            
sex and the ramifications with her two daughters and son and her               
daughters have received counseling at a family planning clinic.                
She discussed the various services her daughters received at the               
clinic.  She thought there were other resources available to                   
address some of the concerns that have been expressed rather than              
changing the possibility of teenagers being able to get access to              
control their reproductive lives, especially responsible teenagers             
who have plans for the future.  Just because a teenager is under               
the age of 18 doesn't mean they're incapable of making some good               
decisions in their lives.  While she may not be pleased with all               
the decisions her teenagers have made, she is pleased that they                
haven't become pregnant.  Speaking as a mother, she believes that              
reproductive rights for both sexes are important and considering               
that teenage years are the age of experimentation with many things             
other than sex, she is hopeful her discussions with her children               
have impacted their decisions and also that the resources are                  
available for them to seek and receive the proper medical                      
intervention needed to make responsible decisions.                             
REPRESENTATIVE DYSON agreed that some children under 18 years of               
age are capable of making adult decisions.  He asked Ms. Conard at             
what age did she think children were not capable of making of adult            
decisions - 13?                                                                
MS. CONARD responded, "I think if a sexually active 13-year-old                
came in and told me that they were having sex and were afraid of               
getting pregnant, they can't find their mother most of the time,               
live with their aunt or other people around the state, they don't              
have a guardian, then I think that child needs first to know that              
some parts of her body should be private - but as you have so                  
rightly said, sometimes these people are preyed upon - I would                 
think that to allow her to become pregnant would be a gross                    
misjustice to her as well as the fact that she's being exploited.              
As a mother and as a nurse, I would also encourage her and empower             
her to control parts of her life so that she wouldn't get pregnant             
and then I would encourage and try to do other intervention so that            
if she's being preyed upon, that that could be rectified as soon as            
possible.  So, I don't care if it's 10, 11, 5 or 2 - if a child is             
being abused, it needs to be addressed.  But if they're at an age              
where they can't control anything, where they are being preyed                 
upon, then I think they must have some resource to not add more of             
a burden on their young lives with an unwanted pregnancy."                     
REPRESENTATIVE DYSON inquired if there were other medical                      
interventions other than contraception and he assumed, abortion,               
that Ms. Conard felt that parents should be cut out of the loop.               
MS. CONARD responded that reproductive information or prevention of            
reproduction should be information that's available to anyone.  She            
would feel very bad if her daughter chose to terminate a pregnancy,            
but she would also feel bad if her daughter was forced to have a               
pregnancy with complications and died.  She stated her belief that             
it is incumbent upon parents to be responsible and talk to their               
children even though she knows it doesn't happen all that often.               
CHAIRMAN BUNDE thanked Ms. Conard for her remarks and asked                    
Jennifer Schmidt to testify at this time.                                      
Number 2125                                                                    
JENNIFER SCHMIDT testified via teleconference from Fairbanks.  As              
a parent and nurse of 27 years, she urged the committee to oppose              
SSHB 372.  She said it's important to prevent unintended pregnancy             
in every way possible - through education of teens and parents,                
encouraging communication within a family but not legislating it,              
and providing preventative contraceptive methods when requested.               
She said the local public health clinic provides almost 400                    
pregnancy tests each year of which a number are young women 19                 
years of age, but 80 percent of these tests are negative.  She said            
it is unconscionable and in her mind, poor practice, to only                   
provide information and encourage family communication and then let            
these young girls leave without a more reliable method of birth                
control. She stated many women with sexually transmitted diseases              
(STD) are identified when they come to the clinic not for sexually             
transmitted disease exams, but because they have already had sex               
and want a reliable method of birth control.  These young people               
may not come in for a STD exam or for birth control if they knew               
their parents would be notified, but if they hadn't come in for the            
birth control method, they might suffer from pelvic inflammatory               
disease or future infertility.  It is the practice for the staff at            
public health centers to encourage young people to communicate with            
their parents.  In terms of medical background, people coming to               
the public health clinic complete a 3-page health history form and             
it's surprising how much information these young people have                   
regarding their family's health history.  It is incumbent upon the             
parents to inform their children of health risks in the family so              
that information can be transmitted to the health care provider                
regardless of age.  She concluded that we do need to encourage                 
communication within families, but legislating it is not the best              
way.  She urged the committee to oppose this legislation.                      
CHAIRMAN BUNDE thanked Ms. Schmidt for her testimony and asked                 
Nancy Rollins to present her remarks at this time.                             
Number 2221                                                                    
NANCY ROLLINS testified via teleconference from Kenai in opposition            
to SSHB 372.  She is the parent of two teenagers and works for an              
organization that provides contraceptive methods and exams to                  
teens without parental consent.  She stated it is critical to                  
prevent teen pregnancy and access to prescription contraception is             
a very important part of the whole picture of prevention of teen               
pregnancy.  She pointed out that teens don't need adult permission             
or parental consent to have sex and most parents who would be                  
outraged with their children being able to obtain contraception,               
would also be outraged to know their children were having sex.                 
It's much safer to take birth control pills than it is to become               
pregnant and most health care providers providing prescription                 
contraception do so after taking a complete medical history and                
giving good counseling to young people about the different methods             
of contraception, including not having sex at all.                             
TAPE 98-35, SIDE B                                                             
Number 0007                                                                    
MS. ROLLINS continued that many teens talk to their parents before             
coming into a clinic and oftentimes, they will inform and involve              
their parents after having the exam and receiving the                          
contraceptives.  She urged the committee to oppose SSHB 372 for                
personal and public health reasons.                                            
Number 0068                                                                    
CHAIRMAN BUNDE asked if it is a possibility that encouraging oral              
contraception will also encourage unsafe sex resulting in more                 
young women becoming susceptible to STDs.                                      
MS. ROLLINS said the organization for which she works also                     
provides, encourages and teaches anyone who is at risk of a                    
sexually transmitted disease to use condoms with every active                  
intercourse.  She noted there are conflicting studies about whether            
or not people using oral contraceptives also use condoms.                      
CHAIRMAN BUNDE thanked Ms. Rollins for testifying and asked Angela             
Moehring to testify.                                                           
Number 0235                                                                    
ANGELA MOEHRING testified via teleconference from Mat-Su on behalf             
of teenagers in the Mat-Su area.  She expressed amazement that this            
discussion was even taking place when sex education is being taught            
in middle schools.  Children should know about the various forms of            
contraceptives and not be afraid to talk with their parents or                 
other adults.  She is of the opinion that most teenagers don't                 
announce to their parents they are having sex.                                 
CHAIRMAN BUNDE asked Jo Campbell to come before the committee to               
present her testimony.                                                         
Number 0320                                                                    
JO CAMPBELL testified she is the mother of a 14-year-old daughter              
and an educator.  She said the testimony relating to the medical               
aspect of birth control sounds great; but her concern generates                
from finding birth control pills in her 14-year-old daughter's coat            
pocket.  Her daughter has been educated since birth regarding the              
family's history of congenital heart disease; however, she was                 
taken to the clinic by one of the junior high school nurses and                
given birth control pills.  Ms. Campbell was unsure why her                    
daughter had been feeling ill, but after discovering the birth                 
control pills, she understood the reason.  She said her daughter is            
not the exception.  She has worked with at risk kids for 30 years              
and the availability of birth control pills does not help these                
children; parental concern and adult guidance is what helps these              
kids.  Taking the adult guidance away from the birth control issue             
will only lead to trouble.  Every week she works with 15 teenage               
girls, the oldest is 20 years of age with two children, and she                
doesn't believe the availability of birth control pills prevents               
these kids from having babies.  Also, the general feeling amongst              
these teenagers is that birth control pills will protect them from             
getting pregnant, but the fact is it does not protect them from                
getting sexually transmitted diseases and a teenage girl and                   
teenage boy who thinks she's perfectly safe to have sex will not               
use a condom.  Her contraceptive choice for her children or any                
other child would be foam and a condom, which will protect them                
from a number of things.  She believes that availability of oral               
contraceptives will lead to an increase in venereal diseases.  She             
said she is really confused because her kids can't rent skis on                
their own, she, in her job, cannot give a child an aspirin, her                
kids can't get their ears pierced before the age of 18 without                 
parental consent, but yet they can get oral contraceptives and get             
an abortion without her knowing about it.                                      
MS. CAMPBELL said the school nurses have indicated they provide                
follow-up with these kids, but most children need verbal                       
instruction again and again; generally the paper work given to a               
child is thrown out without even reading about the maintenance                 
information that's necessary with birth control pills.  Birth                  
control pills are high maintenance, requiring regular visits to the            
doctor and follow-up examinations and most kids will not do that.              
Her concern is that her daughter was not given a choice to call                
home at the time she was given the birth control pills; not one                
adult ever asked if she wished to call her mother.  She believes               
that at some point parents should be allowed to make life choices              
for their children.                                                            
Number 0664                                                                    
REPRESENTATIVE DYSON asked how long it would be before Ms. Campbell            
would know if her daughter's heart was damaged by the birth control            
MS. CAMPBELL responded the family's congenital heart disease shows             
up at different times, depending on a number of things.  Her                   
daughter may not even have it, but her older daughter has it, she              
does and her grandmother has it.  She explained, "It could show up             
when she's 20.  So, if she took birth control pills from now until             
she's 20, her body thinks she's pregnant.  What happens is your                
body thinks it's pregnant all this time, then when you go into                 
labor, that's when you croak - it's a heart, blood thing."                     
Number 0720                                                                    
REPRESENTATIVE DYSON said that existing state law says under                   
examination and treatment of minors, that the provider of medical              
or dental services shall counsel the minor, keeping in mind not                
only the valid interest of the minor, but the valid interest of                
parent or guardian and the family unit as best the provider                    
presumes them.  He asked Ms. Campbell if that was the current                  
practice as she understands it?                                                
MS. CAMPBELL said no, based on her involvement with teenagers in               
the course of her job, she doesn't believe these children are being            
counseled and second, how many 14-year-old children know their                 
family's medical history or would even bother to fill out the                  
questionnaire properly.                                                        
REPRESENTATIVE DYSON asked Ms. Campbell if she had any knowledge of            
children being counseled about the valid interests of the parents              
or guardians.                                                                  
MS. CAMPBELL responded no, most children do as they are told by                
adults and in these cases where the future consequences are                    
uncertain, they need to have an adult whether it be a parent, a                
relative, a teacher or whomever, involved in this big decision.                
CHAIRMAN BUNDE thanked Ms. Campbell for her testimony and asked                
Patricia Mark to testify at this time.                                         
Number 0930                                                                    
PATRICIA MARK, representative, Anchorage American Civil Liberties              
Union (ACLU), testified via teleconference from Anchorage.  For                
clarification she asked if the 13-year-old who received birth                  
control had given the doctor an incorrect medical history or if the            
doctor didn't ask for one at all.                                              
CHAIRMAN BUNDE responded the doctor didn't ask in this case.                   
MS. MARK said the ACLU believes the passage of SSHB 372 would be a             
bad policy decision.  She said the Alaska Constitution                         
unequivocally protects the privacy rights of its citizens,                     
including minors.  No decision is more private than the decision of            
whether and when to bear a child.  If a teenager has to notify her             
parents, she will very likely be discouraged from using the birth              
control.  The ACLU believes this legislation will increase the                 
number of teen pregnancies which will in effect increase the number            
of abortions, which is a much more dangerous procedure.  She said              
that one-third of teen pregnancies end in abortion and there is no             
reason to increase the number of abortions performed in the state.             
She said "Section 1(a)(3) says that a minor child who is the parent            
of a child can give consent to medical services for the minor                  
child.  That kind of seems illogical - why once you become a parent            
can you give consent for your child - I mean, you're not in any                
better control of knowing your medical history."  It appeared to               
her this legislation was thrown together in haste and suggested                
taking some additional time to draft a better bill.                            
Number 1056                                                                    
CHAIRMAN BUNDE asked where in existing law does it state "under                
examination and treatment of minors that the provider of medical or            
dental services shall counsel the minor, keeping in mind not only              
the valid interest of the minor, but the valid interest of parent              
or guardian and the family unit as best the provider presumes                  
REPRESENTATIVE DYSON responded AS 25.20.025.                                   
CHAIRMAN BUNDE asked,"I would really be interested in a reaction               
from the ACLU or anyone in the legal profession about how that's               
addressed when we have, in this case I suppose, school nurses                  
escorting teenagers to get birth control, if the doctor does not               
contact the parent, is the doctor in violation of Alaska Statute?"             
CHAIRMAN BUNDE next asked Cynthia Moehring to present her remarks.             
Number 1120                                                                    
CYNTHIA MOEHRING testified via teleconference from Mat-Su.  She has            
a nine-month-old daughter and doesn't think teenagers should have              
to get a court order to get birth control bills.  She said in this             
day and age, a young woman is expected to have sex by 16 years of              
age and the last thing anyone wants is unwanted pregnancies and in             
order to avoid that, young women should be able to get birth                   
control if that's what they want to do.                                        
CHAIRMAN BUNDE clarified this legislation does not address a court             
order, it requires that a parent be notified if contraceptive drugs            
or devices are prescribed.  Teenagers would still be allowed to use            
all nonprescription forms of birth control if they so choose.                  
Number 1224                                                                    
KAREN PEARSON, Health Programs Manager, Division of Public Health,             
Department of Health and Social Services, testified it is the                  
department's belief the best thing is for very young women to not              
be sexually active; but addressing the fact this bill deals with               
contraceptive access, she would direct her comments accordingly.               
She said the information at the top of the handout came from the               
1995 Youth Behavioral Risk Factor Survey which was a survey done               
with 6,000 young men and women in Alaska.  The survey shows that               
out of 3,866 young women ages 15-17, only 669 were using                       
contraceptives, no young women under 15 years of age indicated use             
of oral contraceptives, 60 percent of the young women who said they            
were sexually active indicated the use of a condom.  The results of            
the survey reveal a couple of things: there are a great number of              
sexually active young women who are not using an oral                          
CHAIRMAN BUNDE clarified for the individuals on teleconference                 
there are 13,422 young women ages 15-17 years of age in the state              
of which 5,956 have been sexually active, 3,866 are currently                  
sexually active, so only about 25 percent of young women between               
the ages of 15-17 are sexually active.                                         
MS. PEARSON said the department was pleased that no young women                
under the age of 15 said they were using an oral contraceptive.                
She said one of the disconcerting things to the department was that            
according to the Bureau of Vital Statistics, between 1980 and 1995             
the number of births to young women under 18 grew from 280 to 415,             
representing a 67 percent increase over a 15 year period.                      
Simultaneously, the births to 18- 19-year-old women held even and              
births to 20-29 years olds dropped significantly.  This indicates              
that something is happening with the 16- and 17-year-old young                 
women and efforts need to be made in the area if information and               
education to prevent that dramatic increase in births to this age              
group.  She remarked there are significant physical risks                      
associated with a pregnancy for a young woman.  One significant                
thing which has not been addressed is that babies born to very                 
young women and a very young partner, are at very high risk for                
abuse and neglect because the parents do not have the maturity to              
nurture and care for these children.                                           
REPRESENTATIVE DYSON asked what is the age difference between the              
young girls who get pregnant and their male partners.                          
MS. PEARSON said the staff of the Bureau of Vital Statistics had               
just compiled that information and she would forward a copy to                 
Representative Dyson.  Basically, the statistics show that of young            
mothers age 13, one father was 1-4 years older, one father was 5-9             
years older; in the 14-year-old mother category, 12 fathers were 1-            
4 years older, one father was 5-9 years older, one father was 10-19            
years older, and one father was more than 20 years older; in the               
15-years-old moms category, 4 fathers were the same age,  52                   
fathers were 1-4 years older, 22 fathers were 5-9 years older, 6               
fathers were 10-19 years older, and 1 father was more than 20 years            
REPRESENTATIVE DYSON asked why are some contraceptive method                   
prescription and others aren't?                                                
MS. PEARSON thought it had to do with the potential medical                    
benefits; the risks and benefit ratio.  Using a condom for                     
instance, basically poses no health risk but any kind of medicinal             
pharmaceutical requires a dispensing authority.                                
REPRESENTATIVE DYSON said in other words the reason that some                  
devices and methods are prescription is because there's a medical              
risk from utilizing it.  He noted that Ms. Pearson opposed this                
legislation and asked if she was opposed to the section requiring              
that a prescriber should make good faith effort to get the medical             
MS. PEARSON replied, "What we believe is that good medical practice            
says that any prescriber, whether prescribing a contraceptive or               
any pharmaceutical, will always make good faith effort to get all              
the history and information to make a good diagnosis."                         
REPRESENTATIVE DYSON reiterated his question of whether she was                
opposed to putting the requirement into law.                                   
MS. PEARSON said she believed it was in existing law which                     
Representative Dyson had previously read.                                      
REPRESENTATIVE DYSON said, "It absolutely doesn't say that.  What              
it says in that passage is that they're supposed to counsel the                
child relationship to the family values and family interest.  It               
doesn't talk about the medical stuff and I want to know why all of             
you who are in this business are objecting to putting good medical             
practice into the law."                                                        
MS. PEARSON deferred that to Dr. Nakamura because she's not a                  
prescriber, but she thought it was in medical practice.                        
REPRESENTATIVE DYSON said, "Then it seems to me that all good                  
medical practitioners would say - that's what good professionals do            
- putting it into law loses nothing and all that you all really are            
objecting to is the idea that parents might know what's going on               
with their kids and that knowledge might preclude the kids going               
and getting a prescription device which by definition has some                 
danger and by definition gives them no protection against almost               
all the STDs."                                                                 
MS. CAMPBELL interjected the birth control pills given to her                  
daughter were not prescription; they were a sample and not                     
prescribed by a doctor.                                                        
CHAIRMAN BUNDE indicated he would continue with public testimony               
and asked Robin Smith to present her remarks at this time.                     
Number 1660                                                                    
ROBIN SMITH testified via teleconference from Anchorage.  She said             
according to the American College of Obstetricians and                         
Gynecologists in 1994 an estimated 910,600 U.S. teenagers between              
the ages of 15-19 became pregnant resulting in 505,000 live births,            
276,000 abortions and 128,000 fetal losses.  That same year nearly             
29,000 women under the age of 15 also became pregnant.  A                      
comparison of these statistics with other industrialized countries             
indicates the U.S. teen pregnancy rate is twice as high as in                  
England, Wales and Canada and more than nine times as high as in               
the Netherlands and Japan.  She said SSHB 372 would punish medical             
professionals who are trying to provide teens with health care                 
which is obviously needed.  This legislation simply does not make              
sense.  Multiple studies have shown that teenage sexual activity is            
not affected by the availability of contraception.  She said, "Just            
today a mother of two teenage boys told me that her son's 19-year-             
old friend had impregnated a younger women.  His father and future             
grandfather of the baby has indicated that this is none of his                 
son's concern and it is all her problem."  Surely, rather than                 
punishing physicians who provide oral contraceptive, which is the              
most effective contraceptive against pregnancy, perhaps the father             
of this teenage boy should be punished for not being responsible               
and for allowing his teenage son to have sex.  Teens will have sex             
and eliminating access to the most effective form of birth control,            
even simply by parental notification, will not prevent teens from              
having sex.  Birth control prevents unintended pregnancies and it              
prevents abortion.  Doctor/patient privacy also allows for the                 
treatment of sexually transmitted diseases.  She said certainly we             
want and encourage our children to seek help rather than to hide               
their problem.  Teenage pregnancy hurts everyone; young women are              
less likely to continue their education, children of teen mothers              
are more likely to be abused, neglected and not to attain their                
full potential, and these children are more likely to become teen              
parents and to continue the destructive cycle.  She urged the                  
committee to fund sex education programs, family planning clinics              
and parenting classes, which will better serve communities than                
this legislation.                                                              
CHAIRMAN BUNDE noted the committee is in agreement with a number of            
the areas addressed by Ms. Smith; certainly the committee does not             
support teen pregnancy, and certainly wants these young women to               
have the ability to grow up without the burden of an unwanted                  
pregnancy.  One of the challenges he's hearing is the other dangers            
of having sex.                                                                 
MS. SMITH said her concern is that kids will have sex with or                  
without birth control and if a teen goes to a physician or other               
health professional to get birth control and finds out that her                
parents have been notified, that word will get spread amongst the              
peer groups and none of the kids will go to get birth control to               
prevent the pregnancies.  Instead, they'll continue to have sex at             
a far greater risk.                                                            
CHAIRMAN BUNDE agreed that teenagers will have sex no matter what,             
he agreed that withholding birth control will not keep teenagers               
from having sex, but the birth control pill is not the only form of            
birth control.                                                                 
MS. SMITH noted that according to a summary on past surveys of                 
teenage pregnancies, one of the biggest things is that boys don't              
like to use birth control and condoms are the only form of birth               
control for boys.                                                              
REPRESENTATIVE DYSON agreed that most of the social problems with              
very young girls are a result of very irresponsible males.                     
CHAIRMAN BUNDE asked Andrea Ellenson to present her comments at                
this time.                                                                     
Number 1950                                                                    
ANDREA ELLENSON testified via teleconference from Mat-Su.  She                 
said, "You were just talking about how not having birth control                
available would not make a teenager quit having sex, but then again            
before that you were talking about 12-year-olds and 13-year-olds               
having sex and how many 12-year-olds know how to put on a condom?              
That's just going to spread AIDS more and it's just going to make              
more teenagers pregnant and yet oral contraceptives do not stop                
sexually transmitted diseases but it does stop the pregnancies - or            
at least helps to.  And not having that available will make it a               
bigger epidemic in the Valley than it is right now."                           
CHAIRMAN BUNDE thanked Ms. Ellenson for her testimony and asked Dr.            
Nakamura to come before the committee and present his remarks.                 
Number 1990                                                                    
PETER NAKAMURA, M.D., MPH, Director, Division of Public Health,                
Department of Health and Social Services, said one of his                      
responsibilities as the Director of the Public Health Division is              
to review and help direct health policy to make sure that when                 
issues are brought up that can affect health, less harm and more               
good is done.  And in reviewing SSHB 372, there is no question the             
intent of the bill is positive; to involve parents with their                  
children.  However, in looking at the wording and the way in which             
the bill is proposed causes him significant concern.   He said, "It            
first says that the provider must obtain records of the client and             
family.  That poses a significant barrier.  Yes, it's nice to have             
as much information as possible, but to try to get the medical                 
records of the client and family is a very major task.  You have to            
get individual consent from each of the adult members of that                  
family in order to obtain their medical records.  Very often it's              
not the same provider that the child encounters that provides the              
medical care to the other parents.  So that provides a significant             
barrier.  To do that, you have to inform the parents, which                    
automatically goes against the reason why the child doesn't consult            
the parent in the first place.  They hope to have their medical                
encounter in confidence.  This ruins that opportunity.  Giving a               
written notice to the parent that the minor has requested                      
contraceptives even is more intrusive and again puts the child in              
confrontation with the parent if they so choose to proceed with                
their care.  The odds are that knowing this, they will not even                
encounter the physician and as mentioned before, probably the most             
significant thing to us is that if this child that is sexually                 
active doesn't have an encounter with the provider, they're not                
going to get the medical consultation and information that's so                
critical to this child.  Not only getting the information about the            
risks of pregnancies, but the risks of sexually transmitted                    
diseases and the long-term chronic effects related to it.  So,                 
probably to us in the health field, it's very critical to have this            
child come in and make the encounter with the health provider."                
REPRESENTATIVE DYSON asked if Dr. Nakamura could suggest language              
that would be less rigorous, but would still place in law that the             
medical provider must do their best to get the significant medical             
history of the child to ensure that child's life is not being put              
at risk.                                                                       
DR. NAKAMURA replied that good medical practice dictates that a                
medical provider already makes all efforts possible to get as much             
information about that patient.  He added, "If you put any kind of             
language or requirements in there that dictates a procedure that               
will break the confidentiality, and you cannot get this information            
without breaking this confidentiality, then you provide the kind of            
barrier that would keep this child from coming in for care."                   
REPRESENTATIVE DYSON said, "So another medical practitioner that               
jumped my bones about this a couple of months ago, said children               
are going to die because they are prescribed these devices without             
it.  He said they're dying now and he said that's the way it's got             
to be because we would rather protect the confidentiality and make             
sure the kids get these devices and avoid the risk of pregnancy and            
abortion, but they're going to die.  And that's just the medical               
risk of dealing with this client population."                                  
DR. NAKAMURA responded that was pretty extreme.  A child will have             
a greater likelihood of dying if she gets pregnant than she will               
from taking any contraceptive device.                                          
REPRESENTATIVE DYSON said that's correct, but for the few for whom             
these devices and prescriptions are counter-indicated, the risk is             
significant and Dr. Nakamura's position is that those children                 
should be subjected to that risk out of ignorance rather than be               
rigorous about getting the information.                                        
DR. NAKAMURA said, "Rigorous about getting the information, I                  
totally agree with and I think you'll find any provider that will              
be rigorous in trying to get as much information.  But relative to             
the risks even to any individual person, the risks from taking                 
contraceptive medications against the risk of medical complications            
from pregnancy is much higher on the side of pregnancy - for any               
REPRESENTATIVE DYSON said that may be true, but what Dr. Nakamura              
was arguing for is medical ignorance.  If there's a chance to get              
that information to protect that population in jeopardy, Dr.                   
Nakamura is arguing in favor of not going after that information.              
DR. NAKAMURA said, "See, I don't know how you can get that                     
information and compromise this child's health risks by increasing             
the risk to pregnancy than by providing the service."                          
Number 2240                                                                    
DR. NAKAMURA said the five-day waiting period is another                       
significant barrier.  He remarked it's quite an intimidating                   
procedure for most children to make the choice to come in to see a             
physician, much less to come in to see a physician about a service             
that is not the most comfortable to discuss with someone the child             
is not that familiar with.  To make the child come back five days              
later to receive the service originally sought, will almost                    
maximize the reality that the child will never come back for that              
second visit.  The consequences of failing to get the contraceptive            
services ....                                                                  
TAPE 98-36, SIDE A                                                             
Number 0005                                                                    
DR. NAKAMURA .... and share the information the child is either                
interested in becoming sexually active or is active, the majority              
of children have a significant degree even with the best of                    
parents, but there are a number of parents who do not have the                 
ability to communicate and provide the support necessary, which is             
evidenced by the 15,000 reports of child abuse and neglect every               
year in Alaska.  If a child is forced to encounter that parent for             
advice and consultation or even to have that parent notified, it               
raises the risk to that child of additional violence or                        
confrontation.  A law mandating the notification would create that             
situation.  In conclusion, he recognized the positive intent of the            
legislation, but from a public health perspective it's more                    
counter-productive than a benefit.                                             
Number 0200                                                                    
REPRESENTATIVE DYSON said, "Dr. Nakamura, just like you wish that              
all the parents were ideal, I wish all the medical practitioners               
were.  Certainly, the information I have is anecdotal, but it                  
doesn't seem to me that the medical practitioners are doing the job            
of being rigorous about exploring the medical risks and I have yet             
to find - and I hope I'm very wrong - that the dispensers have sat             
down and complied with the law and counseled the child about not               
only their best interests, but their family values and the valid               
interests of the parents.  How can we - you particularly from your             
responsibility - encourage that and check up on it and find out if             
it's happening?"                                                               
DR. NAKAMURA said, "I don't have the answer to that, but I can make            
a very positive statement that you'll find that those health care              
providers who take the time to deal with this very difficult                   
subject are some of the best providers out there.  They take the               
time to deal with this very difficult issue and have the                       
information that can be made available to that child - whether the             
child hears it or not, is a question.  But I have a great deal of              
confidence in them and in the health care profession, I'm not just             
saying physicians, but those individuals who deal with this very               
difficult problem."                                                            
CHAIRMAN BUNDE asked who can write a prescription for oral                     
DR. NAKAMURA replied a physician, a nurse practitioner or physician            
assistants working under the direction of a physician.  He pointed             
out that the language in SSHB 372 goes beyond oral contraception;              
it relates to any medical device.                                              
CHAIRMAN BUNDE thanked Dr. Nakamura for his remarks and asked Lana             
Henley to present her comments.                                                
Number 0310                                                                    
LANA HENLEY testified via teleconference from Mat-Su and agreed                
with Dr. Nakamura's remarks.  Her work at the Services for Young               
Pregnant Teens brings her in daily contact with teen pregnancies.              
She doesn't believe that teens are more promiscuous today than when            
she was a teen; both she and her husband had sexual opportunities              
as teens, but the services available today were not available at               
that time.  Today's generation is more educated and is more open               
about sex education.  She thinks of herself as a good parent to her            
teenage daughter and teenage son, but she remembers being deathly              
afraid of her parents when she was growing up even though she knew             
she could talk with them and if her children have that same fear of            
talking to her, she wants them to talk to someone, whether it be a             
doctor, counselor, nurse or whomever.  Taking services away from               
teens is not the answer; there is a need for more counselors in                
schools and people who are more educated.                                      
CHAIRMAN BUNDE thanked Ms. Henley for her comments.  He asked Ron              
Kreher to come forward to testify at this time.                                
Number 0550                                                                    
RON KREHER, Program Policy Analyst, Division of Public Assistance,             
Department of Health and Social Services, said much of the                     
testimony has alluded to many of the medical as well as the social             
concerns regarding this legislation.  His comments would be                    
somewhat more prosaic; i.e., the potential impact this legislation             
would have on public assistance programs with respect to increasing            
the number of minor parents receiving public assistance.  The                  
division believes this legislation is likely to increase the number            
of minor parents through teen pregnancies.  When the federal                   
government adopted the welfare reform law, quite a bit of research             
was devoted to the impacts of teen pregnancies and it is known that            
women under the age of 17 who have children are much more likely to            
become dependent on public assistance and the costs associated with            
providing services to minor parents is up to 30 percent higher than            
adults who have children.  Also, it is known that children of teen             
parents, especially those born out of wedlock, are three times more            
likely to become public assistance recipients than the average                 
population.  He said the division believes there will be                       
significant fiscal impacts as a result of this legislation which is            
indicated on the division's fiscal note.                                       
Number 0655                                                                    
REPRESENTATIVE PORTER asked how the division had determined that               
123 pregnancies would result if this legislation were to pass.                 
MS. PEARSON said, "We took the information that we found basically             
- part of it's in the original bill analysis, but the figures I                
gave you for the number of young women who are using oral                      
contraceptives, which was 669, the research says that about 41                 
percent of young women say that if they had to involve their                   
parents they would not seek contraceptives.  So we took that 41                
percent - brought that down, that's 274 and then the research also             
says that sexually active women not using a contraceptive, 90 out              
of 100 will be pregnant at the end of one year.  So we took the 90             
percent of the 274; that gave us 246 and if we were just going to              
go straight across, we would say 246 are going to get pregnant and             
at that point we no longer had any research, we just made an                   
arbitrary and capricious decision that half of those young women               
would find some other alternative that would work for them - a less            
reliable, you know, foam or something like that - and so that's how            
we came up with the number 123.  Everything can be backed by                   
research to the 246, but when we said half of that, that was just              
our best guess of what would likely happen."                                   
CHAIRMAN BUNDE asked Becca Brown to come forward to present her                
comments at this time.                                                         
Number 0780                                                                    
BECCA BROWN testified on behalf of herself and supported much of               
the testimony that had already been presented.  She agrees that                
SSHB 372 is well-intentioned and that it is intended to benefit                
teenagers and their parents and to promote good communication among            
families.  However, in the end she thinks it's illogical and there             
are probably more effective ways to this end of helping teenagers              
and their families.  First, she thinks this legislation presupposes            
that access to birth control figures into an adolescent's decision             
to engage in sexual activity.  Many studies support her own                    
observations that teenage sexual activity is not affected by the               
availability of contraception and if it's not available - oh, well,            
they'll do without and come what may.  She has read the most                   
successful deterrent to teenage sexual activity is parental                    
openness to discussion of sexual issues with their teenagers.                  
Unfortunately, she couldn't think of a way to mandate parental                 
openness.  Also, she thinks this legislation presupposes that all              
parents are sensitive, supportive and open-minded and she                      
personally, knows that is not the case.  Two years ago she worked              
in a program in Juneau for at risk ninth graders and attended, as              
a volunteer, several Alaskan Teen Institutes.  She has worked with             
a lot of teens who do not even have one parent, much less two,                 
living with them who could be considered fully functioning, stable,            
sober adults, so she doesn't think the parent is always the best               
person to provide counseling.  She agrees that teenagers should get            
counseling from a responsible adult and she hoped that health care             
practitioners could help fill that void when the parent is not in              
a position to provide good counsel.  She said many of the students             
she worked with years ago were abused both physically and/or                   
sexually by their families and in her opinion, it's unreasonable to            
deny these teenagers, many of whom are sexually active, access to              
birth control because they're afraid or unwilling to talk to their             
parents, who may be abusive.  As an aside, three of the girls she              
taught are now mothers and her concern is that many of them were               
not sober while pregnant.  She said unintended pregnancy accounts              
for over three-fourths of all pregnancies among unwed teenagers.               
She pointed out some of the consequences of unintended pregnancies             
are increased abortions, dangerous delays in prenatal care and                 
later on, increases in child abuse and neglect. The consequences               
for teenager mothers are less of a likelihood to finish high school            
or college and they are more likely to be poor and on welfare                  
public assistance.  She stated her belief that anything done to                
prevent unintended pregnancies will improve the lives of teenagers             
and hopefully, their offspring who will come later.  Teenagers                 
should be encouraged to delay the start of sexual activity and for             
those who are sexually active, to promote and encourage the use of             
birth control.                                                                 
MS. BROWN said another issue is that focus is being placed on some             
anecdotal evidence about health care practitioners who obviously               
did not live up to their responsibilities, but it was her belief               
there were existing laws which cover that issue.  It seems                     
illogical to her that promoting access to the pill will increase               
sexually transmitted disease because most health care                          
practitioners, when prescribing the pill, provide a lot of                     
information on sexually transmitted diseases and require a pap                 
smear which is important for sexually active women in preventing               
and early detection of cancer.                                                 
MS. BROWN said in conclusion parents don't have to give their                  
signature of approval when their child has sex, don't have to sign             
for their child to receive prenatal care once they are pregnant,               
nor do they have to sign for their child to get invasive procedures            
such as amniocentesis or to get a Caesarian section.  Why then                 
should the parent have to sign for their child to get birth                    
Number 1120                                                                    
REPRESENTATIVE GREEN inquired if there had been a significant                  
number of males in attendance at the youth counseling sessions Ms.             
Brown had attended.                                                            
MS. BROWN replied it's about 50/50.  The counseling sessions she's             
been involved with in Juneau are run through the National Council              
on Alcoholism.                                                                 
REPRESENTATIVE GREEN said there had been previous testimony that               
sometimes males are not responsive or receptive to the use of                  
condoms and he wondered if there was any difference in the use                 
thereof in the number of males who had attended the counseling                 
sessions as opposed to those who haven't gone through some type of             
counseling or education program.                                               
MS. BROWN said she didn't have any hard statistics, but she                    
certainly hopes so.                                                            
Number 1188                                                                    
CHAIRMAN BUNDE thanked Ms. Brown for her testimony.  He noted that             
HB 420 and HJR 58 would be heard at a later meeting.                           
Number 1200                                                                    
MR. KREHER noted that as part of the federal welfare reform law,               
states that manage to reduce out-of-wedlock pregnancies by a                   
significant portion without increasing abortions are eligible for              
(indisc.) bonus from the federal government.  The state of Alaska              
has a relatively good chance in the third or fourth year of this               
process to be eligible for this bonus.  The possibility that out-              
of-wedlock pregnancies might actually increase if this legislation             
passed could hamper the state's ability to qualify.                            
CHAIRMAN BUNDE thanked everyone for their participation.                       
CHAIRMAN BUNDE adjourned the House Health, Education and Social                
Services Standing Committee at 5:02 p.m.                                       

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