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.