HB 159-STILLBIRTH CERTIFICATE CHAIR WILSON announced that the final order of business would be HOUSE BILL NO. 159, "An Act relating to the issuance of a certificate of birth resulting in a stillbirth." 4:13:44 PM REPRESENTATIVE CARL GATTO, Alaska State Legislature, presented HB 159, as prime sponsor, stating that there are national organizations, which have taken up the matter of acknowledging stillbirths. These organizations have formed to address the situation referred to as Sudden Antenatal Death Syndrome (SADS). Directing attention to the committee packet, he read from "An Open Letter to Members of the Alaska Legislature," from the National Stillbirth Society, Inc. [not dated; original punctuation provided]: The issuance of a Certificate of Birth Resulting in Stillbirth does not impact in any way a woman's right to choose to terminate her pregnancy. Such certificates are issued only for deliveries following naturally occurring fetal deaths. Women who choose an elective termination of their pregnancy would neither be required to obtain a Certificate of Birth Resulting in Stillbirth, nor would they even be eligible for the reason elective terminations don't fall within the definition of a "stillbirth". 4:15:49 PM REPRESENTATIVE GATTO offered that the society was established in 2001, and the founder is available to answer the committee's questions. Recalling his experience of assisting with births, he said that a live birth is "a joy," that is equally balanced by the "shear devastation" of a stillbirth. This legislation asks that the parent's be provided with a certificate to acknowledge the birth, even though it was a stillbirth, he said, and noted that this action has no connection to Roe v. Wade. 4:18:07 PM REPRESENTATIVE ROSES established that the request is for the issuance of a "certificate of birth", not "live" birth, and suggested that the issuance of a Permanent Fund Dividend (PFD) check, could present a problem. Also, an estate may stand to be inherited by the first born grandchild. If the grandchild has a certificate of birth, but does not exist, the intent of the inheritance may be altered. Offering support for the bill, he asked whether these unintended consequences need to be addressed. 4:20:25 PM SANDRA WILSON, Staff to Representative Carl Gatto, Alaska State Legislature clarified that HB 159 would allow vital statistics to issue a certificate stipulating a birth that resulted in a stillbirth. Additionally, it would state that the child not be counted, statistically, as a live birth; effectively disallowing them to qualification for a PFD. She opined that the question of inheritance could be addressed similarly. 4:21:24 PM REPRESENTATIVE ROSES understanding how the certificate would read, retracted his concerns. 4:22:26 PM REPRESENTATIVE FAIRCLOUGH maintained the concern that an issued certificate represents a quantitative factor, entered into the statistical birth records, and suggested that unintended consequences may result. 4:23:01 PM PHILLIP MITCHELL, Section Chief, Bureau of Vital Statistics (BVS), Department of Health & Social Services (DHSS), stated support for HB 159, and offered suggestions for amendment. He described the current practice of issuing a death certificate when a child is stillborn, following a gestation of 20 weeks or more. Current statutes provide for the issuance of a live certificate of birth, or a death certificate only; however, he reported the parents often request an official acknowledgement of the birth. A statutory provision to issue a certificate of birth would help the parents deal with their loss, he opined. The information needed to provided a certificate of birth, is already available to the BVS, contained in the fetal death certificate. He directed the committee's attention to a copy of the vital statistics form titled "Certificate of Live Birth." This form is used to generate a certified copy of birth, issued to the parents. Directing attention to the bureau form titled "Certificate of Fetal Death," he described it as a combination birth/death certificate. He recommended that an additional vital statistics form would constitute a duplication of effort, but that a stillbirth certificate could be issued based on the information gathered on the birth/death certificate. The ability to issue a stillbirth certificate, he said, is merely a matter of authorization. 4:26:28 PM CHAIR WILSON acknowledged the trauma that a parent experiences with the birth of a still child, and stressed that an official certificate would be a supportive gesture. MR. MITCHELL, reiterated that a stillbirth certificate is currently possible, pending legislative authorization. He pointed out that the participating states issue a commemorative certificate, similar to Chair Wilson's description. To a member's question, he restated that creating, and maintaining files for, a document titled "Certificate of Birth Resulting in Stillbirth," would be a duplication of effort. REPRESENTATIVE FAIRCLOUGH stated, "I support a separate piece of paper that is indicating a life." 4:31:09 PM MR. MITCHELL relayed that subsection (g) refers to the issuance of a "delayed" certificate He suggested that this section be reworded to allow a parent to request the BVS to issue a certificate of stillbirth, without regard to whether the fetal death occurred on, before, or after the effective date of this act. Subsection (g) is intended to allow parents to retroactively request a stillbirth certificate, and an amendment to this subsection would provide BVS clearer authority to issue a stillbirth certificate, regardless of when the event occurred. Responding to a question, he stated that about 50 stillbirths occur each year in Alaska. 4:32:21 PM REPRESENTATIVE FAIRCLOUGH offered support for an amendment to allow retroactive certificates, and asked that wording be provided, for a motion. 4:33:48 PM REPRESENTATIVE GARDNER maintained a concern for the legal issues raised previously by Representative Roses. CHAIR WILSON speculated that legal concerns may exist. 4:34:30 PM REPRESENTATIVE ROSES asked if statute requires the issuance of a death certificate. MR. MITCHELL answered that a death certificate is required for anyone who dies in the state. REPRESENTATIVE ROSES inquired if a birth certificate is required, regardless of whether "a parent requests one." MR. MITCHELL responded that the bureau is required to create a birth record; however, a copy is only issued on request. REPRESENTATIVE ROSES compared the information requested on the two certificates currently issued by the BVS: Certificate of Fetal Death, and Certificate of Live Birth. MR. MITCHELL noted that the Certificate of Fetal Death requests a "date of delivery" vs. a "date of birth" because currently a stillborn infant is not recognized as being born live. A stillbirth certificate would also reflect a date of delivery. REPRESENTATIVE ROSES pursued a discussion of renaming the Certificate of Fetal Death, to include "or Stillbirth," and including appropriate information categories. 4:38:31 PM REPRESENTATIVE GATTO stressed that the purpose of HB 159 is not to do clerical and accounting work, or to modify the current fetal death certificate. A parent already has access to these records. The intent here is to provide a mother/parents with something that they don't have, a tangible acknowledgment. He opined that the legal issues can be addressed to facilitate the issuance of a certificate of stillbirth. REPRESENTATIVE FAIRCLOUGH agreed that a grieving family wants a recognition of the birth of a child, that at some point was viable. 4:40:27 PM DARRELL LOGULLO, Volunteer, Mother's in Sympathy & Support (MISS) Foundation, stated support for HB 159, paraphrasing from a prepared statement, which read as follows [original punctuation provided]: Please create Alaska's "Certificate of Birth Resulting In Stillbirth." These six words are of vital importance. Here is why: 'Stillbirth protocols', and the medical courtesies given to mothers throughout Alaskan hospitals (or lack thereof) dictate the parents may be given mementos such as the baby's "crib-card," the wrist or ankle bands, or the handprints associated with the birth of their baby. Yet parents of stillborn babies check out of the hospital with empty arms, broken hearts and sent home with deep wounds. It's easy to understand that any "tangible item" from these traumatic events could be considered essential in the bereavement process. Under this bill, parents who lose a child after 20 weeks of gestation would be issued a "Certificate of Birth Resulting in Stillbirth." As of this letter, the State of South Dakota has been th the 15 state in the United States to adopt such meaningful legislation. Please support the specific wording, "Certificate of Birth Resulting in Stillbirth." If your colleagues have concerns over pro-choice issues, consider following Florida's law th (14 state), and adding clear language, "This Certificate Is Not Proof of Live Birth," to squash those concerns. Please do not allow the wording to be changed, or any amendments offered to dilute or diminish the issue of "birth." Birth is a process: Life or death is an outcome. To no fault of the parents, their child was born dead. Your great state can deem it very appropriate to acknowledge all of Alaska's stillborn children. The fact is: they lived, they died, and that even in their deaths, all of these children very much matter. 4:49:12 PM REPRESENTATIVE FAIRCLOUGH asked how the states, which have adopted this action, have addressed the legal aspects. MR. LOGULLO stated that primarily states have made this an optional document, to assist families in the bereavement process, not a political mandate. Inheritance, and transference, concerns have been addressed by including a disclaimer on the document stating that "this is not proof of live birth." Additionally, he stressed the need to have a retroactive provision, to provide the opportunity for "healing, hope, and help" to every mother who has previously birthed a stillborn. 4:52:17 PM RICHARD OLSEN, Founder, National Stillbirth Association, stated support for HB 159, and underscored that this is not a political question, but rather a recognition that an event occurred. Currently, if twins are birthed, one alive and one still, the stillborn child is not certified. He relayed a story of the mother who formed the MISS foundation, and the event that prompted her to action. Prior to the passage of these bills, mothers have not been able to receive acknowledgment that a child was born, albeit still. He reported that 80 babies are born dead, on an average day in America; the mother's have done nothing wrong, and the cause of death is unknown. It is not a life style issue, he stressed, and to get past the "unknown" cause of death, the acknowledgment, and certification, of the birth is helpful. The numbers of sudden infant deaths, or crib deaths, are fewer than stillborn, but widely discussed and acknowledged. He explained, that when his child was stillborn, and there were no activist groups available, he founded the National Stillbirth Association. He estimated that over one million women in the United States have had to deal with a stillbirth. 4:58:32 PM CHAIR WILSON closed public testimony. 4:58:50 PM CHAIR WILSON suggested that the birth certificate could have a section added to indicate stillbirth, and stressed the need for the parents to have a certificate made available to acknowledge the birth. REPRESENTATIVE GATTO directed attention to the committee packet and the document examples: "Certificate of Birth Resulting in Stillbirth," Indiana; and "Certificate of Stillbirth," Iowa. 5:02:50 PM REPRESENTATIVE ROSES retracted his previous concerns, and stated that based on testimony heard, and the inclusion on the certificate that it does not prove live birth, pledged support for the bill. 5:04:04 PM REPRESENTATIVE FAIRCLOUGH stated that HB 159 directs the administration to word the certificate appropriately, and referring to page 2, line 5, [subsection (d)] she read: "The department shall prescribe the form and content of a certificate of birth resulting in stillbirth ..." Further, she offered Amendment 1, new item [subsection (j)] to read: Any parent may request that the Bureau prepare and issue a certificate of birth resulting in stillbirth without regard to whether the fetal death occurred on, or before, or after the effective date of this act. There being no objection, Amendment 1 was adopted. 5:05:33 PM REPRESENTATIVE GARDNER requested assurance that the unintended consequences regarding the question of inheritance would receive legal attention. 5:05:40 PM CHAIR WILSON announced that HB 159 would be held pending receipt of a committee substitute.