CS FOR SENATE BILL NO. 91(HES) "An Act relating to information and services available to pregnant women and other persons; and ensuring informed consent before an abortion may be performed, except in cases of medical emergency." This was the first hearing for this bill in the Senate Finance Committee. Senator Ward, sponsor, testified this bill requires the Department of Health and Social Services to develop an information booklet and make it available to women "contemplating" an abortion. He spoke to actions of the Senate Health Education and Social Services Committee related to this legislation. Senator Ward commented that Alaska's informed consent process is not uniform. He stated this bill would provide uniform information to those receiving services regardless of their location in the State. AT EASE 9:50 AM / 9:58 AM BOB LYNN, President, Alaska Right to Life Alliance, testified via teleconference from Anchorage to urge the Committee to pass this legislation. He spoke of the medical procedure and the need for informed consent. He talked about the financial benefits to abortion providers for performing the procedures and asserted that relying on these providers to provide information is a conflict of interest. He used an analogy of real estate transactions and the informed consent requirements in that industry and compared the health of a house to the health of a woman. VICTORIA HALCRO, Director, Public Affairs and Marketing, Planned Parenthood of Alaska, testified via teleconference from Anchorage that Planned Parenthood "does more every day to prevent abortions than any other organization in the country." She stated this legislation singles out one medical procedure, which she surmised is unethical, and noted the medical profession has established methods for informing patients about procedures. She asserted that the American College of OB/GYN position is that there is no medical basis supporting statements that a risk of adverse psychological effects related to abortions exists. She continued that there is no evidence that an abortion causes any long-term psychological injury and she suggested there could be long-term psychological effects resulting from childbirth. She opined the information that would be contained in the proposed pamphlet would be presented in a biased manner with the intent to discourage women from choosing to have an abortion. She predicted the pamphlet would not contain statements indicating that an abortion is eight times safer than carrying a pregnancy to term, nor would it state that first-term trimester abortion has a lower complication rate than any other surgery. Senator Olson asked the witness if her testimony is that former US Surgeon General, C. Everett Koop, found no psychological risk for women who have an abortion. Ms. Halcro affirmed. KAREN VOSBURGH, Executive Director, Alaska Right to Life, testified via teleconference from Anchorage that, "informed consent is not as much an abortion issue as it is a woman's health issue." She cited a three-year Planned Parenthood study, which found that post- procedural trauma for abortion patients could be as high 91 percent. She disagreed that abortion providers present adequate information about the procedure, referencing a study compiled by David Reardon, Director, Elliot Institute for Social Services, whereby 80 percent of surveyed women stated they were denied informed consent or were actively misinformed prior to receiving an abortion. She asserted that women are entitled to know the physical and psychological risks that could be incurred from abortions as well as information about fetal development. She listed additional findings in Dr. Reardon's report: abortion is four times deadlier than childbirth, and that three to five percent of women who have had an abortion are rendered sterile. She mentioned a Japanese report that found the rate of sterilization to be nine percent; 14 percent suffered from reoccurring miscarriages; and a 400 percent increase in ectopic pregnancies. She also spoke of suicide attempts and various complications from abortions, including increased risk for breast cancer. She detailed reports of psychological trauma related to abortions. Co-Chair Kelly commented that one of two reporters left the room after hearing the testimony of Planned Parenthood. ANNE HARRISON, Registered Nurse and Nurse Practitioner of Women's Health Care, and Member, State Board of Planned Parenthood testified via teleconference from Fairbanks on her own behalf. SFC 02 # 47, Side B 10:15 AM Ms. Harrison detailed her experiences in working with pregnant women. She asserted this legislation is unnecessary because the health care providers give adequate information of options and possible complications to all pregnant woman. She stated the data cited by the Right to Life organization is inaccurate and distorted and focuses on a small incidence. She predicted an information packet could not be compiled to the satisfaction of groups on both sides of the issue. She reminded this country is established on the separation of church and state and urged the Committee not impose it's views, especially in areas it is not proficient. ROBIN SMITH, constituent of Senator Ward, testified via teleconference from Anchorage in opposition to the bill. She stated she wished efforts could be combined to prevent abortions. She calculated that of the approximately 9,960 births in Alaska in 1999, 48 percent were funded by Medicaid, and that 42 percent of all births are unintended births; therefore 2,100 births were paid by the State. She referenced State information listing the average public cost for an unintended pregnancy carried to term and infant care for one year is $30,000 and she calculated the total cost at $60 million annually. She emphasized the need to reduce the number of unintended pregnancies. She spoke to the psychological problems with childbirth and giving babies up for adoption. JENNIFER RUTTINGER, Executive Director, Alaska Civil Liberties Union, testified in Juneau referencing a position statement dated April 20, 2001 [Copy on file]. She spoke of the organization's mission "to guarantee the individual liberties that are found in the Alaska Constitution and the US Bill of Rights," and it's representation of Planned Parenthood of Alaska on the issue of protecting privacy in the context of medical decision-making for one's own body. She described the 1992 US Supreme Court decision on Planned Parenthood of Southeastern Pennsylvania vs. Casey upholding a Pennsylvania State law requiring physicians to provide women state-prepared anti-choice materials prior to an abortion procedure. She qualified that the Alaska Supreme Court, as well as Supreme Courts in other states, gives the right to choose more protection under their State constitution than the US Supreme Court gives under the federal constitution, which does not contain a right to privacy component. She told of the Alaska Supreme Court decision in Valley Hospital Association vs. Mat-Su Coalition for Choice finding that any restrictions on the private decision of a woman to terminate a pregnancy or to carry a pregnancy to term, would be "held to the highest possible standard of scrutiny." She explained that the State must demonstrate a compelling interest for the need for this legislation as well as demonstrate that the law would not infringe on the right to choose. She remarked this legislation violates the Alaska constitution under the Valley Hospital decision. She stated the medical information required to be included in the proposed material is scientifically and medically "suspect" in some instances, and she noted that neither Dr. C. Everett Koop, or the World Health Organization were able to find psychological harm linked to abortion. She told stories of women for whom a pregnancy would be life threatening and the additional hardship of requiring them to be subjected to this information. She stated this is not in women's best interest. She talked about the higher cost of doctor's required to provide this information rather than nurses, etc. She supported information about all medical procedures. She cautioned against the government making decisions about what information is appropriate. DEB JOSLIN testified via teleconference from Delta about her experience with an unborn child "with multiple anomalies" and the counseling she received urging her to terminate the pregnancy. She decided against termination and detailed her introduction to a support group where she learned of other children with trisomy 13 disorder. She said her child was born with serious heart conditions but was in significantly better health than anticipated and that he was not in pain. She therefore supported this legislation as she thought she should have received more accurate information about the prenatal condition her son was diagnosed with. She informed her son lived much longer than the maximum two days prognosis. Senator Olson asked the sponsor about a witness statement that women are aware of the availability of information on abortion procedures. He commented that in Rural Alaska there are some people who are "less than knowledgeable" about the procedure. He asked what provisions in this legislation address rural residents and if the information would be provided in languages other than English. Senator Ward stated the information would be provided in English. He hoped that any provider would not perform an abortion procedure on a person who was unable to understand what was about to occur. Co-Chair Kelly commented the number of abortions performed in rural Alaska is low, primarily due to the limited amount of State funding. Senator Ward stated Senator Olson's concerns are the basis for this legislation. He relayed the story of a girl who received an abortion in the 1970s and was sterilized. As a result he and wife became involved in counseling against abortion. He stated many women did not receive adequate information. Senator Ward asserted this legislation is about "choice". He also compared the decision to receive medical treatment to that of a real estate transaction, citing full disclosure requirements in real estate. Senator Olson spoke as a physician, that this legislation imposes additional regulations, which he did not support because it tends to require physicians to operate more as technicians than doctors. He asked the consequences of a health care provider not supplying the information proposed in this bill. He commented he assumed that in the instance shared by Senator Ward, the sterilization was unintended. Senator Ward hoped so. Senator Ward opined this legislation would provide a "safeguard", not only for the patient making the decision, but for all involved parties as well. He remarked, "the more information that people have in order to make a decision, I think the better it is." He surmised that the vast majority of patients receiving these services would prefer to have this information. Senator Austerman stated with due respect to moral and religious beliefs, this issue could be divisive. He would not object to moving the bill from Committee, however he informed that he would not vote for passage from the Senate. He ascertained, "obviously, it's an issue that appears to be a veiled approach" to pursue "personal issues." Co-Chair Kelly disagreed the legislation is "veiled" and instead asserted, "it's a straightforward attempt to give people who are going into a potential very dangerous medical procedure, the information that I think has been denied them." He told of the several miscarriages his mother experienced before his birth, and the pressure she was under to abort him as he was not expected to be healthy and because she was in danger of dying. He qualified this occurred in a different time and involves only one doctor. However, he thought this practice continues in some form. Senator Green talked about the extensive consultation she received before undergoing recent routine surgery. She did not think education could be "over stressed" to allow good consumer choices, particularly in relation to medical treatment. Co-Chair Kelly asked about changes to the fiscal note. KAREN PEARSON, Director, Division of Public Health, Department of Health and Social Services, testified the fiscal note incorporates the estimated cost of advertising and additional professional time. At the time the original fiscal note was prepared, she stated, it was assumed the information would be provided in the form of a "simple pamphlet or small booklet", but in reviewing the legislation, it was realized that a much larger publication would be required. She explained this is partially due to the inclusion of a geographic index of services and providers. She stated the increase in funding for professional services is intended to address provider inquiries regarding the publication. Co-Chair Kelly asked the cost of the Department's statutory requirement to advertise Planned Parenthood services. Ms. Pearson replied the Department does not advertise Planned Parenthood services. She clarified, "unfortunately, the terminology that's in the statute happens to match the name of an official organization" and stated the Department's business relates to "planned pregnancy". Ms. Pearson continued the Department and the Division supports the intent of the bill to fully inform patients in any situation. She said the contention, however, is that informed consent is already required for any procedure. She questioned the effectiveness of providing information in written form, given the limited literacy of some patients. She stated that providing various forms of information about avoiding unplanned pregnancy would be a more appropriate approach. Senator Hoffman clarified the witness testified that informed consent is currently required and asked if provisions are stipulated in regulation. Ms. Pearson responded that before any medical procedure is conducted, the patient must sign a consent form. She was unsure whether this stipulation is contained in statutes or regulations. Co-Chair Kelly stated the informed consent provision is different in the instance of abortion procedures due to Alaska Supreme Court decisions. He doubted if informed consent of abortion proceedings "in practice is true." He surmised the witness is misinformed. Ms. Pearson replied she would verify her statements. Senator Leman asked if in light of the existing informed consent practices, why one-half year is required annually to develop the proposed booklet, which he assumed would utilize information already available. He also asked why a full-time clerk position is required to maintain a database and distribute the booklets. SFC 02 # 48, Side A 11:03 AM Senator Leman commented that when a department opposes legislation, it would "inflate" the fiscal note. Ms. Pearson responded she wanted to accurately reflect the expenses to continually update the information. She noted the technical information would not comprise the majority of the cost. Rather, she stated, there would be effort required to update the frequent changes of service providers. She qualified her interpretation of the legislation is to document all agencies, counselors, health care providers and other service providers, which she stated would require constant interaction with communities. She pointed out that if the information could be updated on an annual basis, the fiscal note would be significantly less. Co-Chair Kelly asserted that the content of a signed consent form would be considerably different than the information proposed in this legislation. Co-Chair Kelly commented on the testimony given by the ACLU and Planned Parenthood that there is no psychological impact of an abortion. He pointed out that litigation regarding public funding of abortion services is partially resulting from the argument that medically necessary abortions include the psychological health of the woman. He asserted, "ACLU speaks with a forked tongue." Co-Chair Kelly requested Senator Ward address the concerns related to the fiscal note. Senator Green offered a motion to "move Senate Bill 91 out of Committee with individual recommendations and flocculating fiscal note." Without objection, CS SB 91 (HES) MOVED from Committee with new $110,000 fiscal note from the Department of Health and Social Services dated 4/3/02 12:43 PM. Co-Chair Kelly recessed 11:08 AM / 4:36 PM