Legislature(1997 - 1998)

01/31/1997 09:00 AM HES

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

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