HB 159 - STILLBIRTH CERTIFICATE 3:04:04 PM CHAIR RAMRAS 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." [Before the committee was CSHB 159(HES).] 3:04:43 PM SANDRA WILSON, Intern to Representative Carl Gatto, Alaska State Legislature, sponsor, relayed on behalf of Representative Gatto that HB 159 is intended to give closure to parents of a stillborn child, which [will be defined as a fetal death occurring after a gestational age of 20 completed weeks]. Currently 15 states offer a certificate of stillbirth, and HB 159 proposes to give parents of a stillborn child the option of receiving a stillborn birth certificate in addition to a death certificate. Members' packets, she indicated, contain [copies of a "Certificate of Birth Resulting in Stillbirth" from Texas and Indiana]. She offered her understanding that approximately 1 percent of all births are stillbirths, and that an average of 30,000 fetuses die of Sudden Antenatal Death Syndrome (SADS). House Bill 159 is intended to give parents of a stillborn child the recognition that they had a child. 3:06:38 PM RICHARD OLSEN relayed that on August 17, 2000, he became the father of a stillborn child. After describing his stillborn child, he mentioned that after the stillbirth, he and his wife were left with no record that the birth event occurred. He offered his understanding that a certificate of birth currently specifies that it pertains to a live birth, and characterized this as recognition of another type of birth - a stillbirth. He also offered his understanding that it is virtually impossible for a pregnant woman to cause her child to be stillborn. Stillbirths are naturally occurring events, and the mother of a stillborn baby goes through the same processes as one who gives birth to a live baby, and so the certificate being authorized by HB 159 would recognize that the mother did give birth. He opined that parents of a stillborn child are entitled to that recognition. In conclusion, he attempted to assure the committee that proponents of such certificates are not claiming personhood for the stillborn child. REPRESENTATIVE GRUENBERG referred to the language on page 1, lines 4-8 - which says, "(a) The person required to file a fetal death registration under AS 18.50.240(b) shall advise the mother and, if the father is present, the father of a stillborn child (1) that the parent may request the preparation of a certificate of birth resulting in stillbirth;" - and suggested that the committee insert language stipulating that the notification referred to therein be written notification rather than just oral notification. He asked whether providing written notification would be a difficult process. 3:12:41 PM PHILLIP MITCHELL, Chief, Vital Statistics, Division of Public Health (DPH), Department of Health and Social Services (DHSS), said it would not be impossible to do, adding that the division has considered providing hospitals with some form of information card that they could distribute to parents of stillborns. He also mentioned that information could put on the division's web site. REPRESENTATIVE GRUENBERG suggested that the words, ",if the father is present," be changed to, ", the father if known,". REPRESENTATIVE LYNN suggested instead using the words, ", the father if available,". REPRESENTATIVE GRUENBERG said that that would be fine. MR. MITCHELL indicated that such a change would not create difficulties. REPRESENTATIVE GRUENBERG referred to the language in proposed subsection (b), which in part stipulates that the certificate shall include the last name of the parent who requests the certificate, and asked what would happen in situations wherein the parents have different last names and both request the certificate. MR. MITCHELL said that on a live birth certificate, if the mother is not married, the father's name is not allowed to go on the certificate regardless of parental acknowledgement; therefore, under HB 159, he surmised, the father wouldn't be able to request the certificate. He mentioned that currently if the mother and father are married but have different last names, the division requires them to come to an agreement regarding which last name to use on the certificate. He also mentioned that he would research these issues further. REPRESENTATIVE GRUENBERG opined that these issues need to be addressed in the legislation itself. He then asked whether the legislation would apply to stillbirths that took place in the past. MS. WILSON explained that proposed subsection (g) says: "(g) A parent may request that the bureau issue a certificate of birth resulting in still birth regardless of the date on which the certificate of fetal death was issued." MR. OLSEN, with regard to the earlier question about which last name to use on the certificate, suggested that the same procedures used for certificates of live birth should be used for certificates of stillbirth. MR. MITCHELL, in response to a question, said that the division plans on charging the same fee for a certificate of stillbirth as it currently does for a certificate of live birth - $20. MS. WILSON, in response to a question, indicated that [proposed subsection (h) says, "(h) The department may adopt regulations needed to implement this section.]". MR. MITCHELL added that the division already has the statutory authority to charge fees for its services. 3:19:24 PM CHAIR RAMRAS, after ascertaining that no one else wished to testify, closed public testimony on HB 159. MR. MITCHELL relayed that [the division] supports HB 159, though he suggested that proposed subsection (f) be deleted because the fetal death record already contains all necessary information. In every real sense, he remarked, the division already registers stillbirth events and could start issuing certificates right away. REPRESENTATIVE HOLMES questioned whether the bill needs to have language added that would allow the division to conform its procedure for issuing a certificate of stillbirth with its procedure for issuing a certificate of live birth. MR. MITCHELL said he would check on that point, but offered his understanding that the fetal death record would be the same as a record of live birth, and so it would contain the mother's last name if she is unmarried. He mentioned that the division may need to establish a procedure whereby paternity can be established for the purpose of including it in fetal death records. REPRESENTATIVE GRUENBERG remarked that some of the aforementioned issues of concern could be resolved by the division via regulation if the bill were amended to give the division the necessary regulatory authority. 3:22:57 PM REPRESENTATIVE GRUENBERG made a motion to adopt Amendment 1, to change the language on page 1, lines 5-6, to read, "required to file a fetal death registration under AS 18.50.240(b) shall, if possible, in writing, advise the mother and, if the father is available, the father of a stillborn child". REPRESENTATIVE HOLMES objected. She said that she is assuming that this notification would be occurring in the hospital at the time of delivery, and opined that the term, "the father is available" is ambiguous and could place an unnecessary burden on the division to go hunting down fathers who are not present at time of delivery. REPRESENTATIVE GRUENBERG suggested that the language could be changed, to "if known". REPRESENTATIVE LYNN suggested instead using the words, "makes himself known". REPRESENTATIVE GRUENBERG said he would accept that wording. REPRESENTATIVE HOLMES said she doesn't want to put a burden on the division to round people up. REPRESENTATIVE GRUENBERG restated Amendment 1 such that it would instead change the language on page 1, lines 5-6, to read: "shall, if possible, in writing, advise the mother and, if the father makes himself known, the father of a stillborn child". MR. MITCHELL pointed out that any burden would be on hospital personnel because they are the persons required to file the fetal death record. REPRESENTATIVE HOLMES removed her objection. REPRESENTATIVE GRUENBERG again restated Amendment 1 such that it would now instead change the language on page 1, lines 5-6, to read: "shall, if possible, in writing, advise the mother and, if the father has made himself known, the father of a stillborn child". CHAIR RAMRAS after ascertaining that there were no further objections, announced that Amendment 1 was adopted. 3:28:31 PM REPRESENTATIVE GRUENBERG made a motion to adopt Amendment 2, to delete subsection (f). REPRESENTATIVE LYNN objected for the purpose of discussion. He said he is not sure why this deletion is necessary. MR. MITCHELL remarked that other states that issue such certificates do not create a special record as would be required by subsection (f); instead, those other states just use the same information that is already on the fetal death record. In response to a question, he indicated that the deletion of subsection (f) would result in the language of the bill reflecting best practices as they are known in the states that currently issue certificates of stillbirth. REPRESENTATIVE CARL GATTO, Alaska State Legislature, sponsor, relayed that he has no objection to Amendment 2. REPRESENTATIVE LYNN removed his objection. CHAIR RAMRAS, after ascertaining that there were no further objections, announced that Amendment 2 was adopted. REPRESENTATIVE GRUENBERG asked whether the division would currently be able to resolve - via regulation - potential disputes wherein both parents request that their [different] last names be included on the certificate. MR. MITCHELL said he would research that issue further, but remarked that the division may currently be able to resolve any such disputes given that for certificates of live birth the division is already able to require parents to agree on a last name. REPRESENTATIVE GATTO offered his belief that the division's current regulations already address this point. REPRESENTATIVE GRUENBERG suggested that an administrative procedure could also be used deal with disputes. He then asked Mr. Mitchell to check on the issue of fees. MR. MITCHELL agreed to do so. 3:32:11 PM REPRESENTATIVE GRUENBERG moved to report CSHB 159(HES), as amended, out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, CSHB 159(JUD) reported from the House Judiciary Standing Committee.