HB 338-PHYS LBLTY: GENDER TRANS PROCEDURE;MINORS  1:54:10 PM CHAIR VANCE announced that the first order of business would be HOUSE BILL NO. 338, "An Act relating to physician liability for gender transition procedures performed on minors; and providing for an effective date." CHAIR VANCE opened public testimony on HB 338. 1:54:43 PM MORGAN LIM, Government Relations Manager, Planned Parenthood Alliance Advocates, testified in opposition to HB 338. He stated that PPAA strongly opposes HB 338, a bill that would increase physicians' liability for providing necessary healthcare and result in a severe chilling affect that further limits transgender ("trans") youth access to care. He urged the committee to consider the human costs of the bill and oppose HB 338, thereby ensuring that Alaska is a state that respects and protects the dignity of its residents. 1:56:08 PM DONNA FLEMING, representing self, testified in support of HB 338. She shared a personal anecdote and expressed her support for Section 3 of the bill. 1:57:27 PM CAROL HABEGER, representing self, testified in support of HB 338. She said she supports the bill, as children are not capable of making this life threatening, life changing decision until their brains are fully developed. She opined that physicians should be held accountable until the age of 25. 1:58:59 PM MELISSA ZAHASKY, representing self, testified in support of HB 338. She shared a personal anecdote and opined that physicians facilitating gender reassignment must be held liable for damages incurred. 1:59:54 PM CAROL ROSE, representing self, testified in support of HB 338. She shared a personal anecdote and opined that [physicians] should be held accountable for altering a child's life. 2:01:14 PM KATRINA MITCHELL, representing self, testified in support of HB 338. She urged the committee to implement the bill to ensure that children are not victims of intense social pressure and hasty decisions. 2:02:40 PM ADENA COMPTON, representing self, testified in support of HB 338. She referenced a data leak from the World Professional Association for Transgender Health (WPATH) that highlighted numerous concerns about gender affirming care. She reiterated her support for the bill. 2:04:10 PM MARIE MESSING, representing self, testified in support of HB 338. She expressed concern about the ability of children to provide informed consent in the WPATH standard of care. 2:05:43 PM BRIAN MESSING, representing self, testified in support of HB 338. He urged the legislature to implement the bill to ensure that physicians are liable for gender transition procedures performed on minors. 2:08:29 PM GRIFFEN SUKKAEW, representing self, testified in support of HB 338. He addressed a question asked by Representative Gray during the previous bill hearing, stating that he himself is a happy transgender man who was lucky enough to get on hormone replacement therapy (HRT) at the age of 17. He stated that the bill would make it harder for many trans children to acquire HRT and lead to irreversible harm. 2:09:55 PM SENECA ROACH, representing self, testified in opposition to HB 338. He said whatever the objective, the main effect of the legislation would be to disincentivize medical care practitioners and organizations from treating patients. He urged the committee to vote "no" on the proposed legislation. 2:11:21 PM BILL DEAN, representing self, testified in support of HB 338. He questioned how a child could make a wise decision given all the propaganda and influence from peers and teachers. 2:12:50 PM ALEXANDER ROSALES, representing self, testified in support of HB 338. He likened gender reassignment surgery to gender mutilation and urged the legislature to leave the kids alone. 2:13:47 PM MONICA WHITMAN, representing self, testified in opposition to HB 338. She said Alaskans have made it clear that they don't want the government involved in their healthcare. She opined that creating an environment where physicians are told which treatments they can and can't do based on what the political group in power is suggesting is bad for business. 2:15:15 PM TIMOTHY BARTO, representing self, testified in support of HB 338. He said the bill is designed to protect the mutilation of children by holding medical providers responsible for the damage inflicted on children as a result of a current sociological trend. He urged a "yes" vote on HB 338. 2:16:39 PM LINDSEY BANNING, representing self, testified in opposition to HB 338. She said the bill is designed to make gender affirming care out of reach for trans youth in Alaska because the sponsor has strong feelings about trans kids and their healthcare. She urged the legislature to keep politics out of healthcare and vote "no" on HB 338. 2:18:02 PM JOSH SMITH, representing self, testified in opposition to HB 338. He said by increasing the statute of limitations, the bill would make healthcare unachievable for kids that need it the most. 2:19:28 PM STEPHANIE UZZELL, representing self, testified in opposition to HB 338. She said the bill clearly singles out trans kids, as evidenced by the attempt at criminalizing medical care for children. She said she is appalled at some of the language and that children have a right to autonomy. 2:20:47 PM JESSE SAIKI, representing self, testified in opposition to HB 338. She urged the committee not to support the bill, which aims to limit access to trans healthcare and gender affirming services. 2:22:04 PM DAVID LESLIE, representing self, testified in opposition to HB 338. He opined that the bill is racist and goes against traditional Alaska Native cultural ways, which has multiple genders outside the binary Gender. He said the bill would affect employment in the state and was being deliberately used to attack vulnerable people. 2:23:10 PM JASON LAND, representing self, testified in opposition to HB 338. He said HB 338 is an attack on trans kids and an attempt to scare doctors away from saving kids. 2:24:30 PM ROSE HART, representing self, testified in opposition to HB 338. She said the bill is obviously designed to make gender affirming care harder by increasing liability for gender affirming care providers. She urged the committee not to support HB 338. 2:25:46 PM ERICA STANNARD, representing self, doctor, testified in opposition to HB 338. She said she opposes the bill because patients, families, and medical professionals know what's best for them. She urged the committee to oppose HB 338 and requested that they not continue to waste the legislature and public's time debating care for lesbian, gay bisexual, transgender, queer, or questioning ("LGBTQ+") youth. 2:26:51 PM CARLY JENSEN, representing self, testified in opposition to HB 338. She stated that making doctors more liable for the care they provide would drive doctors out of the state where medical resources are already spread thin. She opined that the bill would further ostracize and harm the LGBTQ+ community. 2:27:57 PM ASHLYN JOHNSON, representing self, testified in opposition to HB 338. She said the bill threatens to undermine trust between doctors and patients, heightens legal risk for healthcare providers, discourages [providers] from offering lifesaving treatment, and limits access to care for transgender minors. Moreover, she opined that allowing legal action for up to 20 years post treatment would add an unreasonable burden on healthcare providers, potentially increase insurance costs, and deter specialists from practicing in the field. She concluded that the bill would jeopardize the future of some of the most vulnerable youth. 2:29:29 PM NITHYA THIRU, Queer & Trans Justice Program Manager, American Civil Liberties Union of Alaska, testified in opposition to HB 338. She said the bill would make it more likely that insurers would not cover gender affirming care for youth due to increased liability, thereby adding another roadblock for trans people. 2:30:36 PM MO DART, representing self, testified in opposition to HB 338. She said the bill is an attempt to scare away medical professionals and limit access to gender affirming care for youth, which is another attack on queer youth. 2:31:53 PM PAMELA SAMASH, representing self, testified in support of HB 338. She said she is supportive of parental rights; however, there is no right to mutilate a child. She urged the committee to "end this" to avoid higher Medicaid payments down the line, and to protect [children's] health and future. 2:33:18 PM XOCHITL MUNOZ, representing self, testified in opposition to HB 338. She shared a personal anecdote and urged the committee to talk to trans people about their experiences and to oppose the bill. 2:34:23 PM JULIE SMYTH, representing self, testified in opposition to HB 338. She urged the committee to oppose the bill if they support kids. 2:35:47 PM REBECCA BERNARD, representing self, testified in opposition to HB 338. She said the bill runs counter to the overwhelming scientific evidence and medical opinion that gender affirming care is medically necessary, lifesaving care for many trans youths. If passed, she said the bill would be an unacceptable and misinformed intrusion by the state into the patient/physician relationship and the right of parents and their children to make their own healthcare decisions. 2:37:11 PM KASEY MOW, representing self, testified in support of HB 338. She urged the passage of HB 338 because minors' brains need time to develop. She urged the committee to hold doctors accountable for the destruction of a child's body and the harmful effects that may follow this procedure. 2:38:26 PM SALIM HOUCK, representing self, testified in opposition to HB 338. They shared a personal anecdote and expressed opposition to the bill because patients, families, and medical professionals, not politicians, know what's best for them. They requested that medical decisions be left to medical professionals. 2:39:40 PM KC CASORT, representing self, testified in opposition to HB 338. She said it's hard enough to be a kid, and [children] do not need politicians making it harder for trans kids by denying them best practice medical care, limiting providers, and stigmatizing their care by singling it out as somehow different from other types of medical care for young people. 2:40:54 PM LILLIAN LENNON, representing self, testified in opposition to HB 338. She said the bill could have profound effects on the health, safety, and stigma of trans people, and is an obvious attempt at intimidating healthcare professionals into denying gender affirming care for trans patients. 2:42:51 PM ROSE TITUS, representing self, testified in opposition to HB 338. She expressed concern that bills like HB 338 could lead to targeting trans adults, queer people, and homeless communities, and denying them medical care as well. 2:43:53 PM JEANNE SWARTZ, representing self, testified in opposition to HB 338. She said the bill is based on fear, ignorance, and prejudice, and expressed concern that the legislature is taking up valuable time on frivolous legislation. 2:44:54 PM ELEANOR LOCKE, representing self, testified in opposition to HB 338. She shared her personal experience and expressed strong opposition to the bill. 2:46:03 PM ELEANOR LOCKE, representing self, testified in opposition to HB 338 because it would increase sex trafficking in Alaska. She explained that when trans youth cannot access appropriate care, they face lifelong discrimination in employment and continuously turn to sex work as a social safety net. 2:46:59 PM WINDY PERKINS, representing self, testified in support of HB 338. She said the bill is about holding medical professionals accountable for mutilating people's bodies. 2:48:35 PM EMILY COHEN, representing self, testified in opposition to HB 338. She encouraged legislators not to overstep their role by assuming they have the expertise and knowledge to know the best outcome in private healthcare conversations between medical providers, families and children. 2:49:33 PM KATRINA DOWELL, representing self, testified in opposition to HB 338. She said this kind of legislation would effectively drive away physicians from an already medically underserved state and negatively impact not only trans Alaskans, but all Alaskan children. She urged the committee to leave decisions regarding gender affirming care to patients, their families, and qualified physicians practicing evidence-based medicine. 2:50:57 PM SERENE O'HARA-JOLLEY, representing self, testified in opposition to HB 338. She said the government has no business telling parents how to raise their children and should not be taking away the rights of families to make decisions with their doctors. 2:52:12 PM MIKE COONS, representing self, testified in support of HB 338. He shared his experience as a paramedic and opined that any physician that prescribes hormonal drugs or performs these surgical procedures in violation of the law has committed child abuse and child sexual abuse. 2:53:25 PM KATE VEH, representing self, testified in opposition to HB 338. She shared her understanding that there are no gender affirming surgeries happening in the state of Alaska and urged the committee to vote "no" on HB 338. 2:54:22 PM MAXINE DOOGAN, President, Community United for Safety and Protection, testified in opposition to HB 338 and opined that the bill is government overreach. CHAIR VANCE closed public testimony on HB 338. She noted that the bill would be taken up again later in the meeting. HB 338-PHYS LBLTY: GENDER TRANS PROCEDURE;MINORS  8:38:06 PM CHAIR VANCE announced that the final order of business would be HOUSE BILL NO. 338, "An Act relating to physician liability for gender transition procedures performed on minors; and providing for an effective date." [Because of their length, some amendments discussed or adopted during the meeting are found at the end of the minutes for HB 338. Shorter amendments are included in the main text.] 8:38:22 PM REPRESENTATIVE GRAY moved to adopt Amendment 1 to HB 338, labeled 33-LS1392\A.5, Gunther, 4/16/24, which read: Page 1, line 1: Delete "gender transition" Insert "certain" Page 1, following line 3: Insert a new bill section to read:  "* Section 1. The uncodified law of the State of Alaska is amended by adding a new section to read: LEGISLATIVE FINDING. The legislature finds that the average prevalence of surgical regret for all surgeries received by all people is 14.4 percent, while the average prevalence of surgical regret for gender affirming surgeries received by transgender and gender diverse individuals is less than one percent." Page 1, line 4: Delete "Section 1" Insert "Sec. 2" Renumber the following bill sections accordingly. Page 2, line 15: Delete "gender transition" Insert "certain" Page 2, line 16, following the second occurrence of "a": Insert "surgical procedure or" REPRESENTATIVE CARPENTER objected. 8:38:29 PM REPRESENTATIVE GRAY stated that Amendment 1 would extend the bill to all forms of surgery. 8:38:52 PM The committee took a brief at-ease. 8:39:27 PM REPRESENTATIVE GRAY opined that Amendment 1 would make the bill more applicable to Alaskans, as they do not receive gender affirming surgery in Alaska. REPRESENTATIVE GROH asked whether gender affirming surgery or home therapy is viewed as a casual matter in Representative Gray's experience. REPRESENTATIVE GRAY explained that he was unable to comment on the surgery because it is not provided in Alaska. Nonetheless, he said hormone therapy is not considered casual in his experience. 8:46:11 PM REPRESENTATIVE SUMNER wondered whether, by passing Amendment 1, few pediatric surgeons would be willing to practice in Alaska. REPRESENTATIVE ALLARD shared her understanding that two major hospitals in Anchorage wanted to perform [gender affirming] surgeries on children and adults, which was stopped due to ethical concerns. She maintained her opposition to Amendment 1. REPRESENTATIVE GRAY agreed with Representative Sumner that allowing children who underwent all kinds of surgery to sue for regret years later would have a chilling effect on pediatric surgery. He reiterated that the point of Amendment 1 is to make the bill applicable to Alaskans, adding that if trans kids can sue in the future, then all kids should be able to sue in the future. 8:48:22 PM A roll call vote was taken. Representatives Gray and Groh voted in favor of Amendment 1. Representatives Sumner, Allard, Carpenter, C. Johnson, and Vance voted against it. Therefore, Amendment 1 failed by a vote of 2-5. 8:48:52 PM The committee took a brief at-ease. 8:49:23 PM REPRESENTATIVE GRAY moved to adopt Amendment 2 to HB 338, labeled 33-LS1392\A.6, Gunther, 4/16/24, which read: Page 1, line 1: Delete "gender transition" Insert "certain" Page 2, line 15: Delete "gender transition" Insert "certain" Page 2, line 17, following "transition": Insert "or cosmetic plastic surgery" REPRESENTATIVE ALLARD objected. 8:49:27 PM REPRESENTATIVE GRAY explained that Amendment 2 would extend liability to physicians to perform cosmetic surgery on minors. 8:50:21 PM REPRESENTATIVE SUMNER said he would be inclined to support Amendment 2, except that it includes cosmetic surgeries for reconstructive purposes and many other inadvisable things. 8:50:49 PM REPRESENTATIVE C. JOHNSON asked whether the doctor or the parents would be held liable. REPRESENTATIVE ALLARD said the argument is that cosmetic surgery should have the same accountability as an untested, unproven medical procedure. She opined that children should not be victims of untested procedures and pointed out that cosmetic surgeries like rhinoplasty and breast reductions have all been proven. She maintained her opposition to Amendment 2. REPRESENTATIVE GRAY clarified that the bill wouldn't ban these procedures. Instead, it would allow regretful patients to sue within 20 years. He explained that "top surgery," which is a mastectomy, for a female to male transgender person is not an untested procedure. Further, he argued that thousands of teen girls get breast implants and that those women should be able to sue for liability if they were regretful. 8:54:43 PM A roll call vote was taken. Representatives Gray and Groh voted in favor of Amendment 2. Representatives C. Johnson, Sumner, Allard, Carpenter, and Vance voted against it. Therefore, Amendment 2 failed by a vote of 2-5. 8:55:11 PM REPRESENTATIVE GROH moved to adopt Amendment 3 to HB 338, labeled 33-LS1392\A.3, Gunther, 4/16/24, which read: Page 1, line 2, following "minors;": Insert "relating to casualty insurance policies  for services rendered by physicians;" Page 2, following line 21: Insert a new bill section to read: "* Sec. 4. AS 21.96 is amended by adding a new section to read: Sec. 21.96.130. Gender transition procedure  liability. A casualty insurance policy offered by an insurer for services rendered by a physician licensed under AS 08.64 may not exclude coverage for claims arising under AS 09.65.175. In this section, "casualty insurance" has the meaning given in AS 21.12.070."   Renumber the following bill section accordingly. REPRESENTATIVE C. JOHNSON objected. 8:55:15 PM REPRESENTATIVE GROH explained that Amendment 3 states that casualty insurance policy offered by an insurer for services rendered by a physician licensed may not exclude coverage for claims arising under the civil liability provision of the proposed legislation. REPRESENTATIVE SUMNER said he opposed Amendment 3 because it could cause a substantial increase in physician malpractice insurance. REPRESENTATIVE GROH said Representative Sumner's point makes the point. He explained that the proposed legislation would create a "giant tail" of liability with a 20-year statute of limitations. For that reason, he said it only seems fair to make that an insurable risk. 8:57:57 PM A roll call vote was taken. Representatives Gray and Groh voted in favor of Amendment 3. Representatives C. Johnson, Sumner, Allard, Carpenter, and Vance voted against it. Therefore, Amendment 3 failed by a vote of 2-5. 8:58:25 PM REPRESENTATIVE ALLARD moved to adopt Amendment 4 to HB 338, labeled 33-LS1392\A.2, Gunther, 4/5/24. [Amendment 4 is provided at the end of the minutes on HB 338.] REPRESENTATIVE GROH objected. 8:59:21 PM MR. BALLINGER explained that Amendment 4 does the following: requires the Alaska State Medical Board to develop a standardized consent form; adds a criminal element to performing these procedures on minors; creates a new section that develops the standardized informed consent for sex reassignment procedures; defines sex reassignment treatments or procedures and inserts this term in place of "gender transition"; removes the ability for a minor to consent to sex reassignment treatments or procedures; outlines exceptions to liability; and makes it crime for physicians to perform the sex reassignment treatments or procedures on minors or individuals over 18 years of age without informed consent with a penalty of a class C felony. 9:05:33 PM REPRESENTATIVE GROH pointed out that Amendment 4 is three times longer than the actual bill and suggested that the sponsor should prepare a committee substitute instead. He shared his belief that considering this amendment in its current form without the aid of Legislative Legal Services or a sponsor substitute is not the way to go. REPRESENTATIVE SUMNER asked whether the transition regulation language and the adoption of a new class C felony would add a fiscal note to the bill. MR. BALLINGER shared that the Department of Law (DOL) said there would be no new fiscal impact on the proposed legislation. REPRESENTATIVE SUMNER pointed out that Amendment 4 directs the State Medical Board to adopt regulations establishing standards of care and asked whether the Department of Health (DOH) had been contacted. REPRESENTATIVE ALLARD answered no and maintained that DOL had said the proposed amendment would not trigger a fiscal note. 9:08:18 PM REPRESENTATIVE GRAY said it would be a surprise to him if standardized informed consent forms weren't already being used in Alaska clinics with regard to this kind of treatment. MR. BALLINGER clarified that the bill would require one consistent with this code section. REPRESENTATIVE GRAY asked whether it was the bill sponsor's belief that current consent practices are inadequate, and that additional government interference is necessary. REPRESENTATIVE ALLARD shared her belief that yes, the government needs to step in to hold doctors accountable. 9:10:35 PM REPRESENTATIVE GRAY asked whether Amendment 4 intended for the Alaska State Medical Board to craft the standardized informed consent form to be completed by the physician prior to starting treatment. REPRESENTATIVE ALLARD answered yes, and shared her understanding that it would not create an additional cost. REPRESENTATIVE GRAY expressed concern that the board may not have anyone serving on it who had performed this type of treatment. REPRESENTATIVE ALLARD acknowledged that this is unchartered territory that needs to be addressed. REPRESENTATIVE GRAY argued that this is not unchartered territory and that standardized informed consent forms had been used for decades. REPRESENTATIVE GROH asked whether Amendment 4 would carry a risk of violating equal protection laws or the right to privacy in the Alaska Constitution. 9:13:53 PM CONRAN GUNTHER, Legislative Legal Services, Legislative Affairs Agency, answered yes, as this is a rapidly developing area of law. He said there would be a risk of creating an equal protection violation and the Alaska Constitution's right to privacy clause. REPRESENTATIVE CARPENTER asked if the bill were adopted and deemed unconstitutional, whether those portions would be struck down and the rest would remain. MR. GUNTHER answered yes and cited the generalized severability clause in Alaska Statutes. 9:15:59 PM REPRESENTATIVE GRAY moved to adopt Conceptual Amendment 1 to Amendment 4 to delete all content on page 5 line 16 and delete the words "over 18 years of age" on line 17. REPRESENTATIVE ALLARD objected. 9:16:36 PM REPRESENTATIVE GRAY shared his belief that it should be a crime to perform a sex transition procedure on anyone without their permission. REPRESENTATIVE ALLARD asked whether it's already illegal to perform any surgery without written consent. MR. GUNTHER said he was unsure about written consent, but informed consent is a standard requirement in medical procedures to give the patients understanding of what they're agreeing to. CHAIR VANCE clarified that the intent of Conceptual Amendment 1 is already written in the bill on page 5, line 17. REPRESENTATIVE GRAY shared his understanding that the bill would criminalize all sexual reassignment treatments or procedures on minors, and the intent of Conceptual Amendment 1 is to ensure that it can't be done one anyone without informed consent. 9:21:27 PM A roll call vote was taken. Representatives Gray and Groh voted in favor of Conceptual Amendment 1 to Amendment 4. Representatives Allard, Carpenter, C. Johnson, Sumner, and Vance voted against it. Therefore, Conceptual Amendment 1 to Amendment 4 failed by a vote of 2-5. 9:22:11 PM REPRESENTATIVE C. JOHNSON said he had a real problem with criminalizing this activity and taking away a doctor's livelihood; furthermore, he disagreed with DOL and shared his belief that Amendment 4 would require a fiscal note. If the bill passes, he suggested that the chair might consider holding the bill in her office and allow for a fiscal note to be drafted, specifically by the Department of Health and Social Services. 9:25:15 PM The committee took an at-ease from 9:25 p.m. to 9:28 p.m. 9:28:52 PM REPRESENTATIVE ALLARD withdrew Amendment 4. 9:29:27 PM REPRESENTATIVE GRAY asked whether "gender transition procedure" referred to surgical procedures only, or whether medication is included as well. REPRESENTATIVE ALLARD said medication is included. She deferred to Mr. Ballinger. 9:29:53 PM MR. BALLINGER stated that without [Amendment 4], which incorporated definitions and some of the other procedures, he is unsure how Alaska would answer that. REPRESENTATIVE GRAY opined that the word procedure implies something beyond giving someone pills or medication. 9:31:42 PM The committee took an at-ease from 9:31 p.m. to 9:39 p.m. 9:39:10 PM CHAIR VANCE sought final comment on HB 338. 9:39:17 PM REPRESENTATIVE GROH expressed concern that the bill has constitutional infirmities and bad policy choices with the "20- year tail" on the civil liability. He added that he could not support HB 338. REPRESENTATIVE GRAY reiterated that gender affirming care procedures are not performed in Alaska other than medication. So, if the bill does not apply to medication, he stated that HB 338 does not have a lot of applicability in the state. Further, he expressed concern about the 20-year statute of limitations for civil liability. He opined that the bill would make it more difficulty for well adjusted trans kids to get the healthcare that they need. REPRESENTATIVE CARPENTER voiced his opinion that minors do not have the capacity to consent legally or developmentally and therefore, the doctor who is in a trusted position, should be ultra cautious in his advice to the patient. REPRESENTATIVE ALLARD said getting a tattoo at 16 is a bad idea, and cutting off body parts is something that children should be protected from. She shared her belief that the legislature needs to stop [these procedures] before they come to Alaska, adding that she stands by the protection of children. 9:44:18 PM REPRESENTATIVE ALLARD moved to report HB 338 out of committee with individual recommendations and the accompanying fiscal notes. REPRESENTATIVE GROH objected. 9:44:47 PM A roll call vote was taken. Representatives Allard, Carpenter, C. Johnson, Sumner, and Vance voted in favor of reporting HB 338 from committee. Representatives Gray and Groh voted against it. Therefore, HB 338 was reported out of the House Judiciary Standing Committee by a vote of 5-2.