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Corrected (pages 4 and 5)
September 29, 2009
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ARIZONA HOUSE OF REPRESENTATIVES
Forty-ninth Legislature –First Regular Session
Minutes of Meeting
House Hearing Room 4 -- 8:00 a.m.
Chairman Barto called the meeting to order at 8:08 a.m. and attendance was noted by the secretary.
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Mr. Ableser |
Mr. Lopes |
Mr. Court, Vice-Chairman |
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Mr. Antenori |
Mr. Murphy |
Mrs. Barto, Chairman |
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Mrs. Goodale |
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Mr. Boone |
Mr. Bradley (excused) |
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HB2158 – DP (7-0-0-2) |
HB2460 – DP (7-0-0-2) |
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HB2159 – DP (6-0-0-3) |
HB2560 – DP (5-0-1-3) |
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HB2164 – HELD |
HB2564 – DP (5-0-0-4) |
Chairman Barto explained that the meeting time was changed because it is Tribal Day at the Capitol and Floor Session begins at 10:00 a.m.
CONSIDERATION OF BILLS
HB2164 – pharmacists; administration of immunizations – HELD
Chairman Barto announced that HB2164 will be held.
HB2560 - certification in medical specialty; disclosure – DO PASS
Vice-Chairman Court moved that HB2560 do pass.
Thomas Desmarais, Majority Intern, explained that HB2560 updates the definition of unprofessional conduct to include falsely representing a physician’s board certification in a specialty or specific procedure (Attachment 1).
Mr. Court, Co-Sponsor, read a letter from Dr. Carl Hyatt in support of HB2560. The letter stated that the purpose of the bill is to protect patients when choosing a physician. Patient safety and proper training and disclosure should come before lucrative returns.
Chairman Barto stated that the bill updates the definition of unprofessional conduct in an effort to protect the public and give full disclosure before medical services are utilized.
Vice-Chairman Court announced the names of those who signed up in support of HB2560 but did not speak:
Bryan Ginter, representing self
David Landrith, Vice President of Policy & Political Affairs, Arizona Medical Association
Vice-Chairman Court announced the names of those who signed up as neutral on HB2560 but did not speak:
Pat Vanmaanen, representing self
Vice-Chairman Court moved that HB2560 do pass. The motion carried by a roll call vote of 5-0-1-3 (Attachment 2).
HB2159 – board of podiatry examiners; continuation – DO PASS
Vice-Chairman Court moved that HB2159 do pass.
Thomas Desmarais, Majority Intern, explained that HB2159 continues the Arizona State Board of Podiatry Examiners until July 1, 2011 (Attachment 3).
Chairman Barto remarked that the Committee of Reference looked at how the Board was doing and the Board’s response to the last audit and recommended what is contained in this bill.
Sarah Penttinen, Executive Director, Podiatry Board, in support of HB2159, reviewed the findings and recommendations of the Auditor General’s Office from the audit conducted the previous fall, and the actions taken by the Board (Attachment 4). She added that there has been a recognized need for existence of the agency since its inception in 1964. She expressed appreciation for assistance from the Auditor General’s Office, noting that much effort has gone into accomplishing the recommendations, many of which are already completed, and the Board will continue to work on the remainder. She said the COR recommended a two-year continuation and asked that the Committee accept the recommendation.
Vice-Chairman Court announced the names of those who signed up in support of HB2159 but did not speak:
Joseph Leonetti, Podiatrist; President, Podiatry Board
Bryan Ginter, representing self
Joseph Abate, Counsel, Arizona Podiatric Medical Association
Question was called on the motion that HB2159 do pass. The motion carried by a roll call vote of 6-0-0-3 (Attachment 5).
HB2564 – abortion – DO PASS
Vice-Chairman Court moved that HB2564 do pass.
Dan Brown, Majority Research Analyst, explained that HB2564 makes a variety of changes to statutes related to abortion including changing the existing parental notification and judicial bypass requirements that apply when a minor is seeking an abortion (Attachment 6). It also includes new requirements that physicians must follow when obtaining the written informed consent of patients seeking abortions. Finally, it allows certain health professionals to abstain from having to facilitate or participate in the provision of an abortion, abortion medication or emergency contraception.
Chairman Barto remarked that parts of the abortion statutes in Arizona have not been clarified or updated for over 30 years, so it is time to make sure women are empowered with accurate information in making an important medical decision. It is well past time that parents’ rights are protected by giving meaning to the current parental consent laws, and to make sure health care professionals do not have to choose between their moral convictions and their jobs.
Cathi Herrod, President, Center for Arizona Policy, testified in support of HB2564. She conveyed that this bill clarifies and updates the Arizona abortion statutes to relate to real world problems. It is designed on laws passed in other states, upheld by the courts and vetted by attorneys with expertise in abortion jurisprudence. It does not stop abortion from happening, but facilitates that clear and accurate information is given before someone makes the decision on whether or not to have an abortion. The informed consent provision requires a 24-hour waiting period before a woman can have an abortion after being given the information. As for the parental consent provisions, the current statute was adopted shortly after the U.S. Supreme Court legalized abortion well before abortion medication was contemplated or that pharmacists or pharmacies were going to be potential distributors of abortion medication, so there is a need to update the law in that arena. Regarding constitutionality of the bill, most of the bill is based on laws from Pennsylvania and Wisconsin that have been upheld in court rulings. Regarding the Arizona State Constitution, it was never interpreted by Arizona courts to provide a greater right to abortion than the federal constitution. In fact, in 2002, the Arizona Supreme Court specifically declined to use the so-called Right to Privacy Clause in the Arizona Constitution as a means to rule on abortion-related issues.
Patrick McNerney, pharmacist, representing self, spoke in favor of HB2564. He indicated that he owns a pharmacy in a rural area. He encouraged the Members to pass the bill because as a pharmacist with a moral conscience, he would like to be able to not be forced to stock certain medicines that can be used for abortions and certainly not to have to sell the medicines to someone who could kill a child in the womb.
Marilyn Yee, Pharmacist, representing self, spoke in favor of HB2564. She stated that clinical data is available revealing the overwhelming significant risks associated with the use of abortifacient, including emergency contraception, and it took 30 years for society to understand the devastating psychological affects abortifacients have had on men, women and children. Considering what is known about contraceptives, especially emergency contraception, a pharmacist should never be forced to dispense against his/her morals. The state law should always err on the side of protecting women, parents, children and the civil rights of healthcare providers.
Chairman Barto noted that Representative
Tom Boone received a letter from Teresa
Theresa Dando that he forwarded to her. She read an excerpt from the
letter of Ms. Dando’s view of why the conscience clause should be part of this
bill (Attachment 6A):
“For over 10 years at the hospital where I work, conscience clause information has been part of our Human Resources policy. The policy outlines the specific steps for practitioners who object to participating in any care that results in an abortion. The process for objection is simple and straightforward and there has never been a compromise in patient care because a staff member refused to participate in an abortion procedure or administer an abortifacient. The conscience clause protections offer a commonsense way to respect your employees’ personal beliefs. Conscience clause protections work.”
Carl Kunasek, retired Senate President, representing self, spoke in favor of HB2564. He said he was a registered pharmacist in Arizona for many years and submitted that every person within a free country should be able to freely exercise their own moral judgment. This is a logical, reasonable measure to allow any individual, whatever their calling is, to follow their conscience. If people do not have that ability, this is no longer a free country.
Victoria Laktash, representing self, spoke in favor of HB2564. She conveyed that she is a post- abortive woman. Over the last 10 years, she worked with post-abortive women and wrote a book containing the stories of the hundreds of women she interviewed and counseled, and all had one thing in common, which is that none felt they were informed. No one told her the psychological effects an abortion could have on her life, the regret she could feel or any of the risks that are involved.
Dr. Enriqueta Porras, representing self, spoke in favor of HB2564. She said she is a board certified obstetrician-gynecologist, and as part of resident training, she was offered an opportunity to train on abortion technique. Most of the residents did not want to participate, and she knew she would never perform an elective abortion, but she chose to view the process because she wanted to be able to inform patients who may be considering an abortion. She went to Planned Parenthood and was appalled at the lack of informed consent. Up to 10 women went into a room and watched a video explaining the process, and at one point, the video said the most common feeling afterward is relief, which is misleading. Each woman had an ultrasound to confirm how far along the pregnancy was, and at least two women asked to look at the pictures, but the requests were denied. The women were taken to a room, which is the first time they saw the abortion provider. One of the patients was crying so violently that the abortion provider said if she cannot calm down, she will not be able to perform the abortion. She said this occurred six years ago and the experience has stayed with her. She asked the Members to pass this bill.
David Maddox, Attorney, representing self, spoke in favor of HB2564. He submitted that there is no accountability in current statute. He filed criminal complaints in two cases, which is the only remedy by statute, and the court will not take those complaints, so the statute can be violated with impunity. There is no clear standard on what is parental consent, what is knowing or voluntary consent, there is no protection against an emotionally induced abortion, which most are, and there is no civil remedy. He said this bill provides a reasonable, confidential means to ensure that parental consent is obtained and contains a detailed description of what must be communicated to obtain knowing consent. The 24-hour waiting period stops emotional inducement and the accountability in civil suits is good. This bill will give him the tools as a lawyer to help people in circumstances when clinics will not do what the law says; it will also help the clinics know what the standards are and what has to be done to follow the standards. He asked the Members to give serious consideration to passage of HB2564, which will protect children and parents in this state. At Chairman’s Barto’s request, he addressed the judicial bypass requirement.
Ron Johnson, Executive Director, Arizona Catholic Conference, spoke in support of HB2564. He surmised that this bill contains commonsense provisions that most Americans would agree with. A recent national poll conducted in January 2009 showed that an overwhelming majority of Americans support provisions for informed consent and parental consent. The bill updates current statute and makes it more meaningful and accountable. Also, the bill makes sure non-doctors are not performing abortions, and protects women, parents, children and the rights of healthcare providers who do not want to participate in abortions or medications that act as abortifacients. He urged the Members’ support.
Rory Hays, Arizona Nurses' Association (ANA), spoke in opposition to HB2564. She stated that the ANA typically does not take a position on elective abortion because the members are divided on the issue; however, she questions if the rights of conscience language strikes a balance to avoid patient abandonment, particularly in emergency rooms where there is a standard of care that must be provided, so she wants to make sure this does not abrogate the standard of care that is required. The second concern is the limitation on the performance of all abortions to physicians only because in certain limited circumstances, with certain kinds of procedures and education, some nurse practitioners may be qualified to do this (Attachment 7).
In response to questions, Ms. Hays stated that in rural areas there is often a single provider in an emergency room, so if an abortion has to be performed for the health of the mother or someone is the victim of sexual assault, there should be clarity on how to maintain the standard of care and protect the rights of the mother, e.g., never have a healthcare provider work alone who filed a conscience statement, etc. Discussion followed.
Chairman Barto read a letter (Attachment
15) signed by 37 doctors, some from rural areas, but mostly from the
Valley, which stated that passing the abortion consent act would empower women
to make informed choices about their health care while ensuring that physicians
are providing the best care possible. Providing women with the best health
care means that only licensed physicians should be performing surgical
abortions, and adding this to the state laws will better protect women. A
doctor, nurse or pharmacist should not be forced to choose between their
livelihood and moral convictions on the issue of abortion. The letter
concluded by stating that the doctors look forward to seeing HB2564 being
passed into law so women in this state can be impelled EMPOWERED to
make informed decisions about their health care and healthcare workers can have
their liberties protected.
Richard Bitner, Legislative Counsel, Arizona College of Emergency Physicians, opposed HB2564. He stated that emergency physicians have to provide care 24-7, 365 days per year for a wide variety of medical conditions, including at times providing therapeutic abortions for women who arrive in miscarriage or other extremis where there is excessive bleeding, and the only medical option to save their life or prevent serious permanent injury is a therapeutic abortion. Also, victims of sexual assault report to the Emergency Department who should be offered prophylaxis for pregnancy and sexually transmitted diseases, subject to informed consent and consistent with current treatment guidelines, and those who find the practice morally objectionable or who practice at hospitals that prohibit prophylaxis or contraception should offer to refer victims of sexual assault to another provider who can provide these services in another fashion (Attachment 8). He stated that the right of conscience provision does not provide an avenue for someone in a small, rural hospital with limited staffing to still perform the standard of care and provide a therapeutic abortion. With respect to the victim of sexual assault, there is no language obligating that the patient be advised that this is an alternative and directing the victim elsewhere if the victim wishes to take advantage of it. Discussion followed.
Ron Johnson, Executive Director, Arizona Catholic Conference, stated that with regard to current statute, as far as therapeutic abortions or things of that nature, the bill does not change that. With regard to updating emergency contraception language, emergency contraceptives are normally taken within the first 72 hours, and it is available now over the counter, except for minors, and even on a website. The idea of every nurse in the hospital objecting to providing it is not likely to happen, but there is a select group of healthcare providers that really do not want their conscience to be violated, which is why this bill is important.
William Chavira, obstetrician-gynecologist, representing self, spoke in support of HB2564. He stated that he has been practicing for nine years in private practice according to the teachings of the Roman Catholic Church. He does not provide artificial contraception or perform elected abortions. As to what would constitute an emergency, he said he has been in situations where women came in bleeding, enclamptic or whatever. If a woman is less than 13 or 14 weeks pregnant and hemorrhaging, or miscarrying, a D&C would be done, which is not an elective abortion, and most of those are performed by a gynecologist. He would have no problem doing that. He had a patient who was 20-weeks pregnant and going into heart failure, so the baby was delivered, but the baby passed. The standard of care is to err in saving the life of the woman.
Vice-Chairman Court announced the names of those who signed up in support of HB2564 but did not speak:
Kelly Townsend, Author, representing self
Deborah Sheasby, Legal Counsel, Center for Arizona Policy
Bryan Ginter, representing self
Ken Fletcher, Student Pharmacist, representing self
Debi Vandenboom, representing self
Jennifer Rondeau, representing self
William Rederick, representing self
Bonnie Rederick, representing self
Cindi Buller, representing self
Jim Cacchione, representing self
Kay Cacchione, representing self
Karen Penazek, representing self
Wayne Penazek, representing self
Carol Lambert, representing self
Julie Kaal, representing self
Vice-Chairman Court announced the names of those who signed up in opposition to HB2564 but did not speak:
Jennie Gorrell, Lobbyist, Business and Professional Women/Arizona
Seth Apfel, Volunteer, representing self
Hillary Pinney, representing self
Heidi McCarthy, representing self
Cindy Armbruster, representing self
Barbara Seese, representing self
Maureen Quirk, representing self
Kathannia Christman, representing self
Bruce Genthner, representing self
Robert Kravitz, representing self
Alice Seaborne, representing self
Sheryl Wells, representing self
Laurie Coe, representing self
Steven Lowen, representing self
Ardis Matus, representing self
Erika Jahneke, representing self
Elaine Hammerschlag, representing self
Myra Baum, representing self
Robert Crouch, representing self
Roger McKee, representing self
Janet Shalwitz, representing self
Michelle Berson, representing self
Cynthia Stout, representing self
Liza Rhima, representing self
Koy Mangan, representing self
Robert Key, representing self
Marie Colangelo, representing self
Heather Hartzell-Robbins, representing self
Michael Cohen, representing self
Marianetta Blackwell, representing self
Agnes Kelly, representing self
Carla Korver, representing self
Trudy Wilner-Stack, representing self
Karin Moores, representing self
Gary King, representing self
Merna Zimmerman, representing self
Karine Aguilar, representing self
Michelle Michelson, representing self
Linda Barter, representing self
Barbara Eisele, representing self
Kirsten Larsen, representing self
Tudie McDaniel, representing self
Janine Connors, representing self
Polly Pinney, representing self
Melanie Burton, representing self
Emily Herrell, Administrative Assistant, representing self
Michelle Steinberg, Director of Public Affairs, Planned Parenthood Arizona
Rachel Gartell, NARAL Pro-Choice Arizona Affiliate Manager
Alessandra Meetze, Executive Director, American Civil Liberties Union of Arizona
Shannon Harper, Government Affairs Director, Planned Parenthood Arizona
Eric Ehst, National Organization for Women
Pat Vanmaanen, representing self
Vice-Chairman Court announced the names of those who signed up as neutral on HB2564 but did not speak:
April Engquist, representing self
Ed Casper, Realtor, representing self
Mindy Rasmussen, Executive Director, Arizona Pharmacy Alliance
Question was called on the motion that HB2564 do pass. The motion carried by a roll call vote of 5-0-0-4 (Attachment 9).
HB2158 – adult immunization information system – DO PASS
Vice-Chairman Court moved that HB2158 do pass.
Dan Brown, Majority Research Analyst, explained that HB2158 establishes an adult immunization information system under the Department of Health Services (DHS), gives health care professionals the option of reporting adult immunization information to the DHS for inclusion in the system and allows patients to request that their information not be disclosed (Attachment 10).
Chairman Barto commented that this bill was heard last year and went all the way through the process. There was pretty much bipartisan support, but it was held up in the last few days of Session.
Jennifer Tinney, Project Director, The Arizona Partnership for Immunization (TAPI), spoke in support of HB2158. She related that TAPI is a nonprofit, statewide coalition composed of the private healthcare and public healthcare sectors that make decisions based on what is believed to be in the best interest of practicing physicians and the public healthcare in regard to immunizations in Arizona. The board and members believe this bill will be very helpful in terms of treating adult patients for immunizations. There is currently a childhood immunization registry, and this bill allows adult providers to share that information (Attachment 11). She said last year there was a measles outbreak in a hospital in Pima County, so in order to prevent healthcare providers from possibly spreading the disease to very vulnerable patients, the healthcare providers had to leave until their immunization status could be verified. If there had been an adult component to the registry, it could have been accessed immediately to see which healthcare providers had an MRR vaccine. Instead it was very costly for the hospital, and in some cases, it took months to track down the records.
Mr. Lopes noted that Page 1, line
22, of the bill requires data to be submitted to DHS on a weekly or monthly
basis, noting that it seems cumbersome not to have a firm schedule.
Ms. Tinney responded that it is up to the provider. There is a web-based
reporting system so there is no burden on DHS on how the healthcare providers
report. Large pediatric practices report daily, some report weekly, monthly or
every other month, depending on what is convenient for the provider. The
provider logs on to the website, which is very secure.
Vice-Chairman Court announced the names of those who signed up in support of HB2158 but did not speak:
David Landrith, Vice President of Policy & Political Affairs, Arizona Medical Association
Pete Wertheim, Chief Legislative Liaison, IASIS Healthcare
Perla Tran, representing self
Richard Park, representing self
Kelsey Lundy, Lobbyist, United Healthcare and APIPA
Richard Bohan, Legislative Liaison, Maricopa County Board of Supervisors
Bryan Ginter, representing self
Don Isaacson, Aging Services of Arizona
Laura Hahn, Executive Vice President, Arizona Academy of Family Physicians
John Linda, representing self
Rory Hays, Lobbyist, Arizona Nurses' Association
Kathleen Pagels, Executive Director, Arizona Health Care Association
Michelle Pabis, Assistant Government Relations Director, Scottsdale Healthcare
Mitch Menlove, Arizona Health Care Association
Debra Kiesner, Executive Director, representing self
Kathi Beranek, Government Relations Coordinator, Blue Cross Blue Shield of Arizona
Pat Vanmaanen, representing self
Mindy Rasmussen, Executive Director, Arizona Pharmacy Alliance
Tara Plese, Arizona Association of Community Health Centers
Amanda Weaver, Executive Director, Arizona Osteopathic Medical Assn
Vice-Chairman Court announced the names of those who signed up in opposition to HB2158 but did not speak:
Seth Apfel, Volunteer, representing self
Alessandra Meetze, Executive Director, American Civil Liberties Union of Arizona
Vice-Chairman Court announced the names of those who signed up as neutral on HB2158 but did not speak:
Barbara Fanning, Legislative Liaison, Arizona Department of Health Services
Question was called on the motion that HB2158 do pass. The motion carried by a roll call vote of 7-0-0-2 (Attachment 12).
HB2460 – mental health services; court costs – DO PASS
Vice-Chairman Court moved that HB2460 do pass.
Thomas Desmarais, Majority Intern, explained that HB2460 exempts counties from being responsible for costs associated with court-ordered evaluations in cases when the individual undergoing a court-ordered evaluation qualifies for health or medical benefits (Attachment 13).
Mrs. Goodale, Sponsor, stated that in the criminal justice system, when a defendant appears under criminal indictment and is required to undergo psychological and treatment services, the County Attorney’s Office bears the full brunt of that expense. This costs the county attorneys millions of dollars annually and it is an unpredictable expense, so it is difficult to set budgets. The bill is intended to help with that process and look to individuals in the system receiving services to help participate in some of the expenses so the full brunt is not placed on the counties.
Elizabeth Hegedus-Berthold, Research Analyst, County Supervisors Association of Arizona, spoke in support of HB2460. She related that she brought this bill forward as a very significant cost saving measure for the counties. The costs for these services are increasing all the time and are very unpredictable. Even when someone has other medical benefits that would otherwise provide for these services, the county is required to pay 100 percent of the costs. The statute has not been updated since Medicaid came into existence. The bill has no fiscal impact on the state as the county would pay the remainder of any cost not picked up for an Arizona Health Care Cost Containment System eligible patient by the federal government. She added that she met with DHS yesterday and agreed to add some clarifying changes in a Floor amendment to ensure that the state is held harmless.
Angela Ferguson, representing self, testified as neutral on HB2460. She indicated that she was court-ordered in September to go through the mental health care system, and she has been battling for five months to get the proper help she needs. The cost of people getting spun around in the system time and time again is what is hurting the state. She said she has drug and alcohol problems and mental health problems since childhood, but by placing her into categories she cannot get the help she needs. She added that a lot of the people in the criminal justice system are there due to mental illness and substance abuse. She submitted that the system should be reviewed and changed.
Vice-Chairman Court announced the names of those who signed up in support of HB2460 but did not speak:
Bryan Ginter, representing self
Dave Hunt, Deputy County Administrator, Yavapai County
Vice-Chairman Court announced the names of those who signed up in opposition to HB2460 but did not speak:
Seth Apfel, Volunteer, representing self
Question was called on the motion that HB2460 do pass. The motion carried by a roll call vote of 7-0-0-2 (Attachment 14).
Without objection, the meeting adjourned at 9:58 a.m.
_______________________________
Linda Taylor, Committee Secretary
March 13, 2009
(Original minutes, attachments and audio on file in the Chief Clerk’s Office; video archives available at http://www.azleg.gov)
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COMMITTEE ON HEALTH
AND HUMAN SERVICES
11
February 25, 2009
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