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House | July 9, 2013 | Committee Room | Health

Full MP3 Audio File

call the meeting to order, please take your seats. welcome too members of the committee, welcome to the guests of health and human services committee into the peoples house. we will be discussing house bill 695 family faith and freedom protection act. the bill is still in the senate clerks office and has not been sent to the house as of yet. normally when a bill is sent to the house for concurrence, it does not go to a committee but directly to the floor for a vote. house leadership feels that the bill should be heard in committee. a notice was sent out last friday announcing todays committee meeting. senate bill 553, originally scheduled for this morning, will be heard 15 minutes after session later on this afternoon. the meeting room for this meeting was changed to this room to accommodate more guests to the committee and to allow 2 hours of discussion instead of 1 hour. overflow is in room 421. the format this morning, the bill sponsors will present the bill, secretary Bosch and Rextel Prat from the department of health and human services will speak. there will be discussion among members of the committee.I'll recognize representatives of various organizations who may address the committee, there will be a time limit of 3 minutes and there will be a 1 minute notice of time remaining. if we have time i will be happy to recognize members of the general public to speak as well. the committee will follow house rules. decency of speech shall be observed and disrespect to personalities carefully avoided. emotions on todays issue run high on both sides. the chair welcomes everyones input and asks that guests respect everyones right to their opinion. i will now recognize the sponsors of the bill to come forward. [SPEAKER CHANGES] thank you mr chairman members of the committee, guests. I'm sorry we're just catching up. what i would like to do since this is the health committee and not the finance or anything else i want to just go through the portions of the bill in detail that are new and not the portions that we had before but I'll go really quickly over it because i tend to be one of those people who reads the table of contents before i read everything else so from a table of contents standpoint the first section starts on page 1 line 21 is actually the bill that we had already passed on foreign law, the sponsors of that were representative Chris Whitmire, Jacqueline Schaffer, George Cleveland, and Larry Pittman and i think some of them may be here but we've already covered that and that does not pertain to this committee because there's nothing directly health related to that one. then if you flip forward to page 3 line 16 this is the part that had also already been through here it does have a health part to it but we had already covered that when it came through the committee the first time, this is whats called the health care conscience protection act, that was the part that was sponsored representative Jacqueline Schaffer, Rena Turner, Debra Conrad, and Susan Martin. I do believe all 4 of them are here. and so we prefer not to bring that back up becuase once again that one has already been through this committee and passed. then if you will advance to page 4 line 13 this is also a portion that has already been through this committee and passed our chamber, this was titled the clarify law to prohibit sex selective abortions, this goes back to the piece about, we don't want to be doing abortions for the purpose of sex selection. the sponsors on that were myself, representative Samuelson, Pat McElraft, Jacqueline Schaffer, and Rena Turner, and I believe all of them are here. so all of those portions, all the way up until you get to page 5 line 35 are all portions that we have already covered in the house and most of them through this committee so those were not the elements that we want to bring up to look at for this committee today. where we will start is on page 5 line 35 and i will have staff go through it but i wanted to ask the senate sponsor, would you prefer to give your comments now or let staff go over the details on that part first. [SPEAKER CHANGES] senator daniel [SPEAKER CHANGES] mr chairman [SPEAKER CHANGES] representative Insko [SPEAKER CHANGES] thank you, may i ask representative Samuelson a question [SPEAKER CHANGES] yes [SPEAKER CHANGES] you didn't cover part 4 on page 1, is that [SPEAKER CHANGES] part 4, which page did you say [SPEAKER CHANGES] line 3 begin on line 33 ???????? [SPEAKER CHANGES] im sorry can you give me

exchange are constrained things. That portion was also hearing the healthcare times and he said it all means chairman of the committee of the city name of the company that offers was one of the center of years ago in some of the times when working women industry countrymen replaced with substandard conditions are taking health and safety of women across the timing of more than 5000 in all (SPEAKER CHANGES) circumstances and licensing decisions these women abortions are the city's planes are also timing and certain amount present an insider's injured is what we expect are uncertainties the surgeons and times in a certain reason the government and is not a regulation doing the right to license for which includes the mystery of the new lease time of his request for the forties and 1970s the reregulation for the 1980s and early nineties was a snub that was during the past four decades the time delays in reaching for the running of substance has been reported as can't use an easier to use a prison sentence Monday for the woman's own reasons and house bills exciting time you're asking was the right to abortion clinics of the bottom of the apartment of users is one share of one last week and are of time and a part of these ways than imminent danger to the Helsinki welfare division's is completely innocent women because no more secluded times in the comment period on a session because wants to protect our citizens and many reasons for your sins responds out from the style houses and countries willing to use someone else's majors and wrestled in the studios of Rio time Physician and president was a seizure and state department of human services to other countries all regulations on and send someone is trying to preserve users again time does anybody know a single is winning city 1. in a string of three double plays substitutions are backing of 61 interesting things to a ?? and he's sitting on a separate cited as the one time, as seen through the wringer also interested in health and safety of the car is now just a limitation ?? (SPEAKER CHANGES) incomes and Cynthia and we're calling this the access application of the time entry on conditions and downing-center enforcement agency report I'm not sure there are plenty to some things you have the time frame mean there are things that are in U.S. taxes extra factions in time now for a planned December, surgical or Cindy reed-training fires and feature writing, Campbell is dead and hundreds of 50 theaters and that isn't frightened of the time is running half hour of all must defend these are the only thing is certain things is that even after I think the market, interment is the resources and one 8th and final tool time feeding grounds and parts of the month ago year series of money and ex-C or private party time for these two individuals releasing things for is a private party EC wrongfully spent five times and was the settlers us print recipes and an interesting as our country things that the security of the time difference between five and the Internet was reports he joins legislators and the economic news services now maintain our importance of time U.S. Congress and the schools are infected after 12013 ?? thinking, Alexander’s the U.S. for fame Forrest Mr. Like this is not a season when you are in a busy time for use on Aussie reality things on the last 48 hours online regarding the time 676 day out page, 44 when we started all 16 opposition the president has one question is, what is what I mean me off this must be present when 18th against retailers simple administration hearing that there's one-S88, actress and one thing at the time has been something rare events and pressure ?? ?? and ?? …….

Something that had come up was, does this imply that they have to come back for every dose? Interestingly, the manufacture of the medication, prescribes that all three of those doses, if you end up having to have three, be done in the presence of a physician. I thought that was something I would be happy to give people copies for of the drug . . . I can't pronounce these things, M-I-F-E-P-R-E-X, which is the drug that is used for that, and the prescriptions that they use for that. So, that does address the fact, that yes, its already required that they come back for those. Then, the other thing, I think that Senator Daniels actually mentioned, in a way, is how long its been since the rules were changed. I had a conversation with someone who used to run an abortion clinic in the 80s, when you had to get a certificate of need and needed surgical care license requirements. So, I do think that things have changed. They've gone from one side to another side. It may be time to consider, figuring out in todays world, how do we need to be doing this. I think secretary ?? has some questions and comments on that, if you would like to recognize her. [SPEAKER CHANGE] Okay, Secretary ??. [SPEAKER CHANGE] Thank you, Mr. Chairman. Thank you, Representative. Since, we recently at the department are aware of this bill. Our department has been reviewing the proposed legislation and still much uncertainty remains. In just a moment I would like our staff to address the uncertainty of these bill. Present is Drexell Pratt, who is the Division Director of Health Services Regulations and Ozzie Conley, of Human Service Regulations, who oversees and survey's these clinics. They are available to address concerns and any questions that you may have. Now, as the Governor said, yesterday in his press conference, we need to ask serious questions about our current regulations. Are the regulations that we presently have sound? Are they reasonable? And, are they being enforced? Unfortunately, on these issues the experts in the Department of Health and Human Services where previously not asked for their input. I would like to take this opportunity to thank the committee for giving us this opportunity to provide some input. The Department of Health and Human Services and the Governor agree with parts of the bill. Such as, the ability of the health care providers to exercise their moral, and religious, and ethical beliefs. We also agree on the need to increase education for expecting mothers. But, the Governor and the Department agree, and we agree on the importance of health and safety for the woman of North Carolina. But, there are other parts of the bill that are far more complex and require further discussion and clarity prior to passing of this bill. In particular, the section 6 provisions about the changing standards for the certification of the clinics. The experts and the professionals at DHHS, believe that some of the most consequential ways we could improve the health and safety to woman would really be to dedicate resource to provide more frequent, regular inspections and to review our existing regulations. In the process of reviewing the present bill, we discovered that regulations for safety have not been updated in our department since 1995 and to our knowledge, there has been no study on how to improve safety in the clinics in North Carolina. One of the biggest regulatory challenges facing our department, is how infrequently we are able to conduct regular inspections of the clinics. The acute care licensing section of DHHS has 10 full time staff, who survey hundreds of facilities across the state, including general acute hospitals, abortion clinics, ambulatory surgical care centers, dialysis centers, and psychiatric hospitals. All this done by 10 people. As a result, DHHS, is only able to inspect the medical component of abortion clinics every 3 to 5 years. Now, for those that disagree with any new rules and regulations, this is unrealistic. As medical science advances we constantly have new information. We must review our rules

Rules and regulations, and we must become current. We have gaps in our existing rules. We must take this opportunity to thoroughly review what is in place and decide how best to improve our policies. I urge you to follow the Governor's advice and leadership and spend more time studying these issues and how North Carolina can best improve the health and safety for everyone. I would like now to request Drexel Pratt the Director of Health Service Regulations to speak. Mr Chairman. [SPEAKER CHANGES] Mr. Pratt. [SPEAKER CHANGES] Thank you Mr. Chairman and members of the committee. DHS has some technical concerns as mentioned centered on part 6 of the bill amendment to Men and Women's Right to Know Act. First off let me say, I know it has been addressed briefly here this morning, we at DHHS we do not have authority to regulate physicians in the practice of medicine. We don't do that. We do report incidents where physicians we believe have done something that may have lead to the harm of injury of a patient. So we do report those. But in section 6A, discusses a physician being present during an abortion procedure or administration of medication. There's several areas of this section where it is unclear from a regulatory perspective what is intended to occur. First, on the surgical abortion issue, which is referred to in lines 46 to 48 of the page 5, the term "during the performance of the entire abortion procedure" is not defined. It could mean just a surgical procedure or it could include all aspects of the abortion procedure from the initial procedure work up through recovery. Additionally, it is unclear term "physically present" means what exactly is required. These are terms that we need to understand. What was intended so that we can properly assess what is going on in these clinics. Second, the requirement to have a physician physically present in the same room during the administration of a drug or a chemical, which we've heard about already, to induce an abortion which is on pages 5 and 6 line 48 and 2 could be interpreted to mean present during administration of all drugs or chemicals to complete the medication abortion procedure or it could be interpreted that the physician would only have to present during the administration of the initial drug or chemical as this is inducing, as the bill requires, phase of the medication. As standard drug procedure, three doses has already been mentioned approximately three days apart with the abortion procedure generally finishing 4 to 5 hours after the last dose though it may take up to several days after the last dose. This regulation could be interpreted to mean that the woman would have to return to the facility to get the physician to administer the follow-up dosages. This is not standard medical practice currently in other circumstances. The HHS does not have information at this time to determine whether this would actually improve safety. DHHS was not charged in the bill to write rules for section 6A because that falls under other's regulatory authorities, however, as mentioned earlier regulation can cite non-compliance with these matters if it is determined that the violation has resulted in a threat to the patient's health and safety. The DHSR also has technical concerns with section 6C in the bill which requires the department to amend the rules for abortion clinics to similar to rules of ambulatory surgical centers. The key phrase that lacks definition is "similar to," and the rule development process DHHS will have to define "similar to" and have documentation to support that definition. It is likely this rule will (as you are familiar with the 150B process) it is likely this rule will receive 10 layers of opposition before the rules review commission and be sent back to the general assembly for further action. Before it can actually be enforced. As an example quality assurance measures are required for ambulatory surgical centers, but it is unclear whether they would be required for abortion clinics under this regulation. In addition, the language asks for the department to ensure that standards for clinics are similar. This could be interpreted that any change pertaining to an ambulatory surgical center would require revision of the abortion clinic regulations as well. Further it is unclear which of the requirements of license of ambulatory surgical centers this bill intends to be applied to for abortion clinics. The mandates that it be similar but then goes on to specify two requirements that DHHS adress...

band does the endangered and more discussion would rile his own years of his behavior only those two of us were all records and Mr. Starr should be playful work for her on endorse articles and dry lawyers as one of the coasters in addition to receiving abortion clinics of the ordeal and standards time reserves and wife and Mr. Simpson and we have to do time on Dole and more unusual state needed this is not yet, and when of this conversion calls for existing abortion clinics on the repeal of ?? abuse prevention of section six segments of the breastbone 500 days of time here haven't currently making a spectacle readable. And often longtime member of the union address is one of only a system partition calls from sun to replace an existing tile Indians and the intent is the stellar 2477 two specifically address transferring to point a time or another server is an integrated life and generally require that a provision for review archer Barnes and we're certainly won the battle for survival senate amendments that in the commencement from a report in the salty has sufficient or active opposition of the senate to spend time together along the larger , recalling effective regulation for a closer watch and the other part time, and there he knows of some form of a converted its positions Johnson and for some receivers and area hospital which is the same time on the nation's largest of the Senator Joseph Biden three only one-on for deals and was stationed for pointing out that while tile. For others, it would have similar to the opposition to the current time for all you do a better and more of the timecard and only 18 in a rosary was heavy weapons under-performed in defending the portable awarded Thailand for a dissident factions and most of the differences for a personal and corporate image and ??(SPEAKER CHANGES) 97 and this makes abortion clinics at least once every two years and four from the routing level of the second time: one, is expected of 3 to 5 years into four of the 20 years in prison sentence for the politicians say used increase the frequency of the meantime are set for below -the second. We have been full of employees and dependents of his office but I'll know which one of only a few years of the agenda is a smaller nations taken place of the county of a few of the opening splash ??. If all four of the addition of apartments arrivals and the anybody having a party which was a little some of these of which are China has been wandering from being the only region is for is some way in which I managed to- mainframes. Now that we appreciate on Wednesday night on the Times' a monopoly is a series of these tales we now have 14 steals in thinking often $1.00 in the late 18th year and I'm calling his neck out the sanctity of remaining interest is not always found error in reporting on time clear the same ¬, getting mighty status and for what the second time in the words and deeds in the early and it was making process down and we gave ?? ?? ……….

the rulemaking process a few years ago, people are still adjusting to it. We also have new staff in the departments who are also adapting to our rules making process. The Senate worked with staff, sent over what they thought was clear definition particularly using the comparison to the ambulatory care centers that would provide the type of coverage that the Department needed and says they were willing to accept to rewrite the rules. We are realizing as we met with them, that there may need to be more clarity, we are not exactly sure so the Senate and the House are willing to continue working with you all on figuring out how to make, if the language is clear, okay, then let's work with it. If the language needs to be clarified, then let's figure that out but I wanted Senator Daniels to comment on that but we are in agreement that the goal is safety, the goal is not to shut down clinics and we will work with you all to figure out how to do that in the best way. [SPEAKER CHANGES] Thank you Representative Samuelson and Mr. Chairman. I appreciate the Secretary's remarks and I look forward to working with you to improve the contents of this bill and to give further clarity for your department. [SPEAKER CHANGES] Secretary ?? did you have anyone else that wished to speak over there? [SPEAKER CHANGES] Just for questions since we have the person who really goes to the clinics to regulate it if there was a question. [SPEAKER CHANGES] Okay, thank you. I will now open up discussion among members of the committee and to start off with, I want to keep the discussion among members of the committee somewhat brief because I want to spend a lot of time to hear from the public and with that, we will go ahead and start. Representative Insko. [SPEAKER CHANGES] Thank you, Mr. Speaker. I want to make a brief statement and then I have some questions for Dr. ?? or Mr. Drexall. One of the favorite old sayings my parents often said to me is actions speak louder than words and I think there is a lot of evidence that the intent of this bill is not primarily to protect the health and safety of the women. I appreciate the comments that have been made, I think this is very helpful what we are hearing, but there are so many examples of what has been done this year that would really undermine women's health and access to reproductive health. Denying the expansion of Medicaid is an example [SPEAKER CHANGES] Mr. Chair, a point of order. I believe in this discussion she is going far afield of what we are anticipating discussing; she is going into other bills and things that have been passed and she is impuning the motives of what Representative Samuelson just said. [SPEAKER CHANGES] Representative Stevens,the point is well taken [SPEAKER CHANGES] Mr. Speaker [SPEAKER CHANGES] Wait a minute, Representative Insko. We will give some latitude to members of the committee for now, please continue. [SPEAKER CHANGES] Thank you and let me just say that I don't perceive that when someone disagrees with me, that they are impuning my motives. We have disagreement among, in a democratic society is very important, no one has all the answers, it is very important to have open and free discussion and try to resolve differences cordially and that is my intent. I do want to add that this specific issue regarding access to women's health for pregnant women would deal with the proposal to remove women from Medicaid who were between 130 and 185 percent of poverty so that did actually direct impact on women's health care. The comments that I have, the questions that I had for Dr. ?? or Mr. Drexall are, you mentioned the cost to build an ambulatory care center, you didn't comment on the cost to operate one and have you had a chance to look at the cost between operating an ambulatory care center and a current abortion clinic? [SPEAKER CHANGES] Mr. ?? [SPEAKER CHANGES] No, Representative, we have not looked at the cost of operation; what we were trying to look at was the physical plant cost of actually constructing a facility that meets the requirements similar to or equal to an ambulatory surgical center and that is what these costs were based on. [SPEAKER CHANGES] And I have just 2 or 3 more questions. [SPEAKER CHANGES] One follow up [SPEAKER CHANGES] Can you tell me of the abortion clinics that we have, how many have no findings against them regarding safety or regarding impairment

to anybody's health. No findings. [SPEAKER CHANGES] Mr. Pratt. If I may, I'd like Ms. Azzie Conley to answer those questions, since she's in charge of the inspection [SPEAKER CHANGES] Based upon [SPEAKER CHANGES] Ma'am, excuse me. If you would identify yourself for the Committee [SPEAKER CHANGES] Yes I'm Azzie Conley, I'm the section chief for the Acute and Home Care Licensure and Certification Section within the division of Health Service Regulation. In regards to the question, at this point, we do not have a clearly defined time frame. If we were looking over an extended period of five to ten years, it would be safe to say that each of the abortion clinics have had some type of deficiency or violation of the regulations. In regards to whether or not it would meet the definition of clearly a safety issue or a true quality of care issue, we would need to do a review of our data to come back with a final answer. [SPEAKER CHANGES] Can I make just one comment? [SPEAKER CHANGES] Briefly, please. [SPEAKER CHANGES] And that is that I do agree that if you really are interested in protecting the health and safety of the women, the best way to do it is to increase the inspections of the clinics. [SPEAKER CHANGES] Representative Jones. [SPEAKER CHANGES] Thank you Mr. Chairman. I appreciate the opportunity to just briefly comment and perhaps steer the discussion back toward the actual content of the bill. I would like to reiterate, as one of the chairs of this committee, and I have been inundated with all kinds of interest regarding this bill from folks probably both in this room and around the state for the last few days. And it's interesting how much focus and discussion there has been on the greater issue of abortion, in you will, and how little of the discussion has actually focused on the contents of this bill. ?? That really is what we're here to discuss and I would, once again, point out the unusual nature of the meeting that we're having here today. I would once again point out that the vast majority of the Senate PCS, the House Bill 695, has already passed this house after quite lengthy committee discussion and floor debate. It has been pointed out that those sections have to do with foreign laws with no sex-selective abortions and with health care conscious protection. We've already covered all that ground pretty thoroughly. I would point out that the purpose of this discussion is to give the members the opportunity to discuss those portions of this particular bill that the House members have not previously discussed. And I would again point out that this is quite an unusual step. Generally when a bill comes back from the other body for a concurrence vote, it goes straight to the floor. We don't have such an occurrence as this but I would point out that there was 4 day's notice for this meeting and here we are today, having this discussion. So what do the new sections of the bill cover? The new sections of the bill simply provide that doctors must be present during the abortion procedure. Furthermore, we are requiring the abortion providers to meet some minimal standards. To something similar to what other health care providers such as ambulatory surgical centers have to do. The question of cost just came up. I don't see anything in the bill that says that we are proposing new ambulatory service centers to provide abortions. But i do think it's important that we have some minimum health care standards and it's not unreasonable to require that these clinics would have the same reasonable standards that these other surgical centers would have. Mr. Chairman, I would point out that most people that call themselves pro-choice on the abortion issue say that they want for abortions to be safe and rare. I would say that the new sections of the bill are all about that. They're all about fairness and equal treatment for these woman patients by securing basic health and safety standards. I would hope that we could all agree that all surgical centers should have the same standards of safety and that no health care patient should be subject to sub-standard health care facilities. A surgery center should not be allowed to have lower safety standards just because all the patients are women or because the procedure involved is abortion. I believe that we need to demand the same level of safety at women's surgery centers as we would for any other surgery center. I refer

more suggest that there not be any special treatment or loopholes for these particular women's clinics. We have heard already and it's been pointed out in the news that recent events in our state at various abortion clinics are clear examples that we need to make improvements to ensure safety for all these women. It's been pointed out that just in the past couple of months one abortion clinic in Charlotte was shut down by DHHS due to the improper administration of drugs. [SPEAKER CHANGES] Mr. Speaker, Ms. Chair, point of order. [SPEAKER CHANGES] President Baskerville. [SPEAKER CHANGES] That has absolutely nothing to do with the content of this bill. [SPEAKER CHANGES] I disagree, I disagree. [SPEAKER CHANGES] Mr. Chairman. [SPEAKER CHANGES] May I continue? Thank you, Ms. Chair. I believe that we're talking about improving the safety standards of clinics in North Carolina. I would submit humbly that when clinics in our state have to be shut down because of improper safety standards that perhaps that relates to the contents of this bill. I would just cite that even this past week we've seen another abortion clinic in Durham have to be shut down for lack of quality control procedures. So I would conclude my remarks and just say that I would hope that whether a person identifies himself as pro-life or they favor the choice of abortion on demand that they would want any women's clinic in this state to be held to the highest safety standards. I believe this is a common sense approach. I believe it's in the best interest in the better health of the citizens in our state. Thank you, Mr. Chairman. [SPEAKER CHANGES] Mr. Chairman. [SPEAKER CHANGES] Representative Insko. [SPEAKER CHANGES] May I ask Representative Jones a question just for clarification? [SPEAKER CHANGES] OK. [SPEAKER CHANGES] Representative Jones, I'm assuming and I don't want to assume. I want to know whether or not you actually favor the ambulatory surgical center standards for abortion clinics. That would be helpful for me to know that. I've heard Sec. ?? talk about maybe some more regulations but not to meet that standard and so I'm curious about your position on that issue. [SPEAKER CHANGES] Representative Insko, I have to admit that I'm a little bit still confused about some of the comments that I heard earlier. I do agree with what Sen. Daniel and Rep. Samuelson said. I believe that the supporters and the sponsors of this legislation are certainly willing to work with the administration as far as any language. Quite frankly I think you could go in and make an inspection of every abortion clinic in North Carolina at 5 o'clock every afternoon and I'm not sure that you're going to answer all the questions that this bill provides for. For instance, is it reasonable to require that a doctor actually be present during the procedure. I believe that it is. Now that might be . . . you may disagree with that. But quite frankly I don't know how that 5 o'clock inspection is going to guarantee that that happen. So I think that's a good provision. I think it's reasonable to have the Department of Health and Human Services allow resources to be available on their website so that women can get more information. I think that's reasonable. You see, when I received the emails that I received this week from my constituents and I actually engaged those folks on the contents of the bill, I didn't get any answers back and I'm still looking for some of those answers. So I think the specific provisions of this bill are good. I think if there's technical changes that need to be made in language so that everybody can follow it, that's a good thing. Furthermore, I'm not really sure how I can further answer your question. [SPEAKER CHANGES] Representative Earle. [SPEAKER CHANGES] Thank you. I've got a question for staff and then a comment. On page 6, section 6C, could you kind of tell me what some of the requirements will be that, I guess, are currently now in place for the ambulatory centers. Could you tell me some of the requirements, please? [SPEAKER CHANGES] Ms. Johnson. [SPEAKER CHANGES] I can go through some of the current requirements for the ambulatory surgery facilities. The bill indicates that the role

This would need to be similar, and so given that the roles do not exist at this time I can't specify how exactly this will correlate with the certifications of ?? of abortion. There are several regulations ranging anywhere from what information has to be on the application for a license are, the minimum standards for construction and equipment including building code requirement that involve plumbing, HVAC, electrical things among those lines, they also have sanitation requirements, and specific requirements for their operating ??. Adjacently there are ?? through this quite a few with plumbing and electrical. They also contain regulations involving medical records, the itemization of charges, personal records, laboratory services, medication and anesthesia regulations as well as radiology and pharmaceutical services. Regulations go into details involving house keeping and quality assurance, and then the nursing administration on their staff. Some of those topic areas are already covered with ?? for clinics of abortion as well, but those are specific topics for the ambulatory ?? facilities. [SPEAKER CHANGES]: Thank you, I guess my point is that I have gotten some correspondence from different places and some of what are received say that they would have to make adjustments to the parking lot, to the surgical sinks, to the colors of the paint used, and I am fine to figure my mind how this has anything to do with the safety for women, and it has more to do with limiting access because also I am hearing that all of the facilities would be closed with the exception of one. So, to me it is quite clear that we are talking about more about access anything else, and I would just like to quickly address some of what I have heard already about the doctors being present. Will you know we allow home ?? where no doctor has to be on site at all. So, I am thinking that having a baby is one of the most serious health issues that women could experience, and we allow that without having doctors available, and it seems to me like the process of inspections of these facilities is working. If we have got to that's been closed because of violations then I think that that process is working. We just need to give the department the resources to do on a more regular basis, and I think they could do a better job, and when we talk about safety, I want us to be very clear that if we close this facilities, we are talking about sending women back to the backroom kinds of places that used to exist because if a woman wants to have an abortion, she is going to have an abortion, and I would prefer women having a place to go that is a let's say the sanitary, and I think that's what we need to be concerned about in that sending women back to unsanitary, substandard backroom conditions where folk that are not trained, and I would just like to say that I think this bill needs more study, it needs to be looked at, and I think we just need to send this certainly not tested it out it here as it is. Thank you. [SPEAKER CHANGES]: I would ask the members of the committee to keep their points brief. I want to make sure we get to members of the public and so at 11 O'clock which is seven and half minutes we are going to go to the members of the public. Representative ??. [SPEAKER CHANGES]: Thank you Mr.chairman, I try to be very first allot a red hearing is being thrown out, and ?? men and ?? women and stuff thrown out. I would just like to sheet one down very, very quickly.

And that's this whole business of Medicaid expansion, has absolutely nothing to do with women's health whatsoever. Pregnant women are covered up to 185% of Federal poverty now, that's more than the Obama Medicaid expansion covers, so it's a complete red herring, it has nothing to do with pregnant women, or women with children and the like. It has nothing to do with children, it has nothing to do with breast cancer coverage and cervical cancer coverage it goes up to 200%. Those folks are already covered by Medicaid now, currently, so if people would kindly get off of that, or get their facts straight. I would like to ask Mr. Prax just a very quick question on this matter of regulation, and my question is this, and I'm trying not to be too pejorative, but I don't know any other way to ask it, and that is, if the clinics, for example, the clinic that's been mentioned in Charlotte, and the most recent clinic that was closed down in Durham, had they been required to have a higher level of certification or licensure, or higher level of standards, isn't it fair to say that those facilities, maybe wouldn't have had to have been closed down, had they had to adhere to some higher level of operational standards and regulations? [SPEAKER CHANGES] Representative Dollar. [SPEAKER CHANGES] Thank you Mr. Chairman. Representative Dollar, the two clinics that you mention were actually cited and closed for existing rule violations, to say that additional standards, I would be unsure whether that would make any difference because there were already standards in place that affected those particular clinics, and that was what was used to actually close those facilities. [SPEAKER CHANGES] Just one quick follow-up. [SPEAKER CHANGES] Follow-up. [SPEAKER CHANGES] Right, but the standards and procedures and what you have to do in order to operate something on the order of an ambulatory surgical center is far greater than what is required under the certification that, for example, the clinic in Durham was supposed to be operating under, is that not correct? [SPEAKER CHANGES] Absolutely [SPEAKER CHANGES]Is that correct?[SPEAKER CHANGES] Thank you Mr. Chairman. Absolutely. The requirements are much more stringent in an ambulatory surgical center than is currently in an abortion clinic.[SPEAKER CHANGES] Thank you [SPEAKER CHANGES] Representative Farmer-Butterfield. [SPEAKER CHANGES] Thank you Mr. Chair. They say if you listen long enough, a lot of your questions have been answered and comments made, but I do want to comment to the department that I genuinely appreciate your assessment of this bill, and what it means to your department. I think it's honorable, I think it's good to have people to come forward and actually state facts, and that's what we need here. It's a very important issue. My question is, first of all, what procedures specifically apply in this bill to ambulatory surgical units? I think that's already been alluded to, but I want the bill sponsors to talk specifically about what they had in mind when they proposed this legislation. [SPEAKER CHANGES] Representative Farmer-Butterfield, who is your question addressed to? [SPEAKER CHANGES] The bill sponsors. [SPEAKER CHANGES] Senator Daniel or Representative Samuelson. [SPEAKER CHANGES] Restate your question, please. [SPEAKER CHANGES] Which procedures or regulations specifically did you have in mind to apply to this bill from the ambulatory surgical centers. [SPEAKER CHANGES] If you'll notice, the language doesn't say they have to do it exactly the same in every way, it gives them, through the rules-making process, to determine similar, standards that are similar to those for licensure of ambulatory surgical centers. In the rules-making process, they would look through and decide which of those pieces need to be similar, and which ones aren't, and what go through that rules process. So that's not our job, as one and not that one, they would look and say "here's what you got for ambulatory care, here's what we're doing in an abortion clinic, how do we bring that up to the same sort of outcome and the same sort of provision on that?" There again, that's what we've said to them, if that needs to be clearer, we're willing to talk with them about that, and I said that in the beginning. [SPEAKER CHANGES] Representative Earl just cited some that are not specifically related to women's safety and health, and that's why I was asking. The other question I have is what type of quality assurance measures did you have in mind when you devised the bill. [SPEAKER CHANGES] Quality assurance for what in particular? [SPEAKER CHANGES] In terms of looking at standards and regulations for the centers themselves.

the abortion centers? [SPEAKER CHANGES]. That would be part of the rules-making process that they would look at. I don't have the full statute in front of me on what you do do for ambulatory care right now. And so we, again, did not give specifics in that way, we wanted them to look at it. The intent, there again, was safety. And to make sure if you're preforming a form of surgery that you have the safety provisions that are needed to make sure that that surgery can be done safely. [SPEAKER CHANGES]. Do you agree...? [SPEAKER CHANGES]. One more follow up. [SPEAKER CHANGES]. Follow up. Do you agree that the fact that two centers have closed means that it's working, and that it will not deter, hopefully, young people from going to other means of abortions, in that two were closed, that means something is working if somebody is doing the job of making sure that imminent danger is not there for women, is that correct? [SPEAKER CHANGES]. We've never said that we thought none of them were working well. We just believe that it's time to review the standards that have not been reviewed since the early 90's, and look at it and determine whether or not, given current standards today, do we need to improve it. If they were to go through the rules-making process, do these comparisons, and say, you know, we're almost there, that's something they can give us feedback on, but it's not that we're coming out and saying, gee look at all these problems. We're saying, it's 2013, these rules have not been reviewed since 1994. In fact, when I looked back over the rules, they had been reviewed twice in the 70's, another time in the 80's, another time in the 90's. It's time to review them again. [SPEAKER CHANGES]. Thank you for those comments. I don't know what the Senate had in mind, I'm sure you do, but it seems to me like a study is very appropriate. Given all the factors that you just mentioned, that's even more so a reason to do a study and be thorough and approach this. Thank you. [SPEAKER CHANGES]. The Senate has agreed to talk to, we're all going to work together, figure out, is this clear? It may be clear in the language it is. We just need to talk about it some more. If it needs to be clearer we'll, he said we're open to considering that. The point is here, that we want these standards to be the standards that provide the women in North Carolina the safety they need when they go in to have a surgical procedure. [SPEAKER CHANGES]. The final Representative to speak, or to ask questions, is Representative Fulgham. [SPEAKER CHANGES]. Thank you, Mr. Chairman. Question for Secretary Wos. The currently licensed facilities in North Carolina for delivery, medical care, I count among the surgical centers, mandatory surgical centers, hospitals and the abortion clinics, 254 facilities. Are not all of those technically licensed to do abortions? [SPEAKER CHANGES]. If I may answer, Mr. Chairman? [SPEAKER CHANGES]. Mr. Pratt [SPEAKER CHANGES]. The acute care centers that are licensed other than abortions, abortion centers are certified, but the licensed facilities are licensed to do a host of surgical procedures. Abortion clinics are only certified to do abortions. So the answer, I guess, to your question is, there are other facilities that can do abortions, but usually it's because of complications with pregnancies and things like that. They don't hold themselves out to advertise or bring in clients just to do abortions. [SPEAKER CHANGES]. Follow up, Mr. Chairman. My question was premised on the basis of some type of crisis occurring if bad places, unregulated in the sense that not complying with regulations, or shut down, that is few and far between. But this clinic in Durham for example, was just recently shut down. It only had been open for less than six months. And your frequency of inspections belies some of the rhetoric from some of the people I've heard recently from the other side indicating abortion clinics were inspected on an annual basis. This is not the case from what I can understand. And so, what I'm asking is, the '94 recent, most recent regulations involving the administrative code for abortion clinics, as applied to the 16 clinics as they stand now, 9 of those clinics were in existence prior to 1994. Are all the clinics in current compliance with the regulations as of 1994, or are there some that have been grandfathered in, for example, in regards to structural integrity with the hallways, the usual kind of things that go along with a medical facility delivering medical treatment, not the ambulatory surgical standard, but the abortion clinic standard? [SPEAKER CHANGES]. Mr. Pratt. [SPEAKER CHANGES]. Thank you, Mr. Chair. All of the clinics today are assumed to be in compliance until we find otherwise, whether it's a routine inspection or whether we get a complaint. We are assuming they are in compliance. [SPEAKER CHANGES]. And one final comment, I'm sorry, Mr. Chairman... [SPEAKER CHANGES]. That's fine, one final follow up. [SPEAKER CHANGES]. ...I just want to make this point.

...the finding in Section 6C of the bill that says "similar standards" is exactly what it means, then I'd discuss with some of the sponsors. I'm satisfied if the current 94 standards were enforced, they would be adequate and would cover. It doesn't address parking lots and all that other kind of nonsense. We're just talking about basic safe facilities. Separate recovery rooms. Separate operating rooms. Medical procedures being outlined and recorded. Patient records being held and having some sense of integrity in regards to that situation. But Pennsylvania, Kansas and Virginia have come to the standard where now abortion clinics are required to have the same exact standards as ambulatory surgical centers and be subjected to unannounced inspections. I don't think this bill suggests we go there. I don't think we need to go there if the regulations are enforced as they are written. Thank you, Mister Chairman. [SPEAKER CHANGES] We're now going to move to comments from members of the public. Secretary Wos, thank you to your staff for coming today and answering questions before the Committee and your presentation. I understand you have a busy schedule, but I thank you for coming. [SPEAKER CHANGES] Thank you, Mister Chairman. Thank you for this opportunity. [SPEAKER CHANGES] Thank you, Secretary and I was going to say we also, as sponsors look forward to following up with you all in the next 24-48 hours to continue this. [SPEAKER CHANGES] Thank you, we look forward to working with you. [SPEAKER CHANGES] Members of the public, we welcome your opinions. Thank you for your patience and what I'm going to try to do is have three people speak who are against the bill and then three people speak who are for the bill, and then we'll go from there. We'll keep it to three minutes. You'll get a one minute notice that your time is about up and please keep it to that time limit if possible. First person we'll hear from is Suzanne Buckley, from NARAL. And she'll be followed by Sarah Preston, ACLU and Paige Johnson, Planned Parenthood. So if those two would also be ready to present. When you come up to the microphone, please identify yourself and the organization you represent. Miss Buckley. [SPEAKER CHANGES] My name is Sarah Buckley and I am the Executive Director for NARAL Pro Choice North Carolina Foundation. We oppose House Bill 695 and we urge you to do the same. I just want to be very clear, this bill has nothing to do with women's health and safety. This bill will only make it more difficult, if not impossible, for women in North Carolina to have access to safe and legal abortion care. This bill imposes numerous medically unnecessary and excessive requirements that only apply to providers of abortion care. We already have 18 pages of regulations that apply only to providers of abortion care. It's one of the most highly regulated procedures in North Carolina. This bill would require abortion providers to have transfer agreements with local hospitals that may be difficult or impossible for them to obtain. And all United States hospitals are required by federal law to treat emergencies. Transfer agreements are simply unnecessary. Their only purpose is to create another barrier to safe and legal reproductive health care. When legislation like this has been enacted in other states, it has forced clinics to close their doors. In every single state. And that's the point of this bill, and you don't have to take my word for it. Representative Stam said so on Saturday on WRAL. This bill will not reduce the need for abortion care. It will only make it less safe. This bill is out of touch with more than three quarters of North Carolinians who believe lawmakers have no place in a woman's personal and private decisions. The vast majority of North Carolinians, thousands of whom you have seen on Moral Monday, want you all to focus on jobs, the economy and increasing access to health care. Not stripping away women's choices. We urge you not to concur on this bill. Thank you. [SPEAKER CHANGES] Sarah Preston, ACLU. [SPEAKER CHANGES] Good morning, my name is Sarah Preston and I am the policy director for the American Civil Liberties Union of North Carolina. As an organization dedicated to protecting Constitutionally guaranteed rights, including the right of women to make reproductive health care decisions privately and without government intrusion, we have serious concerns about House Bill 695. 695 bans coverage for abortion as part of plans...

Offered through state health insurance exchanges unnecessarily and burden regular clinic that perform abortion, a safe a constitutional protected procedure and interferes with the doctor patient relationship. We know from experience in other states, that this legislation particularly part six of this bill will in fact shut some clinics down. This legislation will limit women access to safe constitutionally protected health care services and North Carolina women should of had the opportunity to weight in on this legislation on the Senates side. We believe that women and the public should have been given the opportunity and should be given the opportunity to weigh in fully and instead this provision was tacked on to the end of a unrelated bill with no notice to the public and no opportunity for meaningful input before the senate floor vote the same day the bill was heard in committee. This bill has serious consequences for the lives and health of women in the state. It deserves serious debate and consideration and a open process with the opportunity to run amendments , but instead the public was given no opportunity to comment and amendments were shut down in the senate. Here in the house the public may be getting some time to comment and we certainly do appreciate that, but once again any concern or questions raised could not be addressed since members of this body can not offer amendment during a concurrent debate. One day of public comment in the house does not make up for the rushed and premature vote on this bill. Nor does it somehow correct the process this bill has gone through so far. When dealing with the health and lives of North Carolinian women, The North Carolina general assembly should do better and spend the time necessary to make sure all the women in the state can access a full range of reproductive health care and that no woman's life is jeopardized do the actions of this body. We will urge you to not concur and to take the time necessary to really review this subject. Thank you very much. [SPEAKER CHANGES] Paige Johnson with Planned Parenthood [SPEAKER CHANGES] Good morning I'm Paige Johnson Vice President of Internal Affairs for Planned Parenthood of Central North Carolina.Thank you for giving us the opportunity to speak. No one takes women health and safety more seriously than Planned Parenthood. More than twenty-five thousand North Carolinian's women, men and young people rely on us every year for life saving cancer screenings, pap test, clinical breast exams, annual exams, birth control, STD detection treatment and prevention and yes high quality compassionate and safe abortion care. We understand how deeply personal and often complex pregnancy decisions can be for a woman. Which is why we cannot understand how law makers could pass sweeping legislation like six ninety five without allowing a single women's health expert to weigh in publicly, when the bill was still eligible to be amended. Like all health care provider, doctors who provide abortion care in North Carolina adhere to rigorous medical standards and numerous regulations. Our doctors are licensed by the North Carolina medical board and receive continuing medical education annually. Our medical standards and guidelines are informed by the most trusted medical knowledge as well as professional and scientific organizations including the CDC,the FDA, and The American College of Obstetricians and Gynecologists existing laws and regulations governing abortion care in North Carolina work. This is why, exactly why providers that did not comply with these intensive regulations were shut down. House bill six ninety five as written will do nothing to improve women's health or safety, it is simply another step towards eliminating access to safe and legal abortion taken by those opposed to women right to make deeply personal and private decisions under all circumstances. If the intent truly is to make abortion care safer to protect women health and safety, Planned Parenthood welcomes the opportunity to work with law makers to improve. Amend house bill six ninety five we urge you to not concur with the bill as written. Thank You [SPEAKER CHANGES] We will now hear from three people who are for the bill. We will start off with Tammy Fitzgerald from North Carolina Bayou Correlation.

followed by John Russtin, Northland Family Policy Council, and then Barbara Hotz, North Carolina Right to Life, Ms. Fitzgerald. Thank you, Mr. Chairman. There are 2 drugs commonly used for chemical abortion, Mifeprex RU486 and Methotrexate. Both drug regimens involve substantial risk including excessive hemorrhaging and the possibility that the pregnancy is not terminated, and a surgical abortion is necessary. Both drugs can also cause death. The FDA approval letter for RU486 states, Mifeprex should be prescribed only in a clinic, medical office or hospital, by or under the supervision of a physician, able to assess the gestational age of an embryo, and to diagnose atopic pregnancies. Physicians must also be to provide surgical interventions in cases of incomplete abortion, or severe bleeding or have made plans for such care to others, and be able to ensure patient access to medical facilities equip for blood transfusions and resuscitation if necessary. FDA protocol also requires 2 subsequent office visits with the physician. Methotrexate on the other hand, is approved only for cancer, sclerosis, and hemorrhoid arthritis treatment. Off label use if for abortions. Medical evidence shows that there are more complications from chemical abortions than from surgical abortions. The American College of Gynecology reports that 1 out of every 100 women who undergo chemical abortions will require emergency surgery for hemorrhage. This percentage does not include the additional women who need surgery for incomplete abortion, continuing pregnancy, and other indications. Women who have chemical abortions typically endure significant pain and bleeding. These drugs are not like taking Motrin. Abortion clinics in North Carolina have had their share of problems, like the 2 in Charlotte and in Durham that were shut down within the last 2 months. State officials called a preferred women's health care clinic in Charlotte an imminent health and safety threat to women, and even found dead insects, blood splatters and even dirty instruments inside the facility. State Health officials also found the facility was endangering women by improperly administering chemical abortions, and improperly examining post-abortive women before they were discharged before surgery. According to an inspection report on April 20th, the clinic was found to be improperly dispensing intravenous version of Methotrexate orally, causing failed abortions that necessitated surgery. According to the Charlotte Observer, Dr. Mitchell Krinon, the Chairman of the University of California at Davis, Department of OBGyn said that it is no different than hearing that an Orthopedic surgeon had cut off the wrong leg. Although this was the 2nd failed inspection of a preferred women's health clinic, the clinic was allowed to re-open by the State 4 days later. State officials closed the Baker Clinic in Durham lat Friday because it presents an imminent danger to the health, safety and welfare of clients, that's their quote. State officials found the facility failed to perform quality controlled testing on 108 patients that received RHD testing. [SPEAKER CHANGES]Excuse me, the lady will conclude her comments, since time has run. [SPEAKER CHANGES]Okay, thank you. All of these problems will be cured under Section 6, of House Bill 695. Requiring doctors to be present for abortions is not wild eyed and crazy. It is what common sense requires, and FDA protocol demands, it's what the drug manufacturers themselves recommend, what Planned Parenthood even has on their website. Requiring abortion clinics, excuse me. [SPEAKER CHANGES]The lady will please conclude. [SPEAKER CHANGES]I have 1 more minute. Thank you. [SPEAKER CHANGES]5 seconds. [SPEAKER CHANGES]Pretending abortion is not a serious medical procedure jeopardizes the health, safety and very lives of women, just so the abortion industry can produce more profits. I urge you to vote for concurrence. [SPEAKER CHANGES]Next is John Russtin, Northland Family Policy Council. [SPEAKER CHANGES]Thank you Mr. Chairman, members of the committee. I'm John Russtin, President of the Northland Family Policy Council. I will be brief with my comments, and Mr. Chairman if it would be possible, I would like to defer the remainder of my time that I would have finished to Ms. Fitzgerald for her comments. I appreciate this opportunity to speak in favor of House Bill 695. As the House has already vetted and approved the majority of provisions in this bill, I will focus my comments on Section 6C, which directs the Department of Health and Human Services to amend its rules to require abortion clinics to meet similar standards to those of ambulatory surgical centers in North Carolina. This is a common sense requirement designed to help

Protect the health and well-being of women who seek abortion services in our state. Particularly when those services involve an invasive and I stress an invasive surgical procedure. As Senator Daniel has stated already, the Senate was well justified in including this provision in House Bill 695. Particularly in light of the atrocities that were revealed throughout the murder trial of Philadelphia abortionist, Kermit Gosnell. And if that were not enough, and you have had heard this stated several times already, much closer to home, the North Carolina Department of Health and Human Services has temporarily suspended the operation of two abortion clinics in our state already this year. One in Charlotte in May and one in Durham just last week. Due to conditions and you’ve heard this before, but I think it is important to stress again. Due to conditions in both clinics and I quote from the Department’s Notice of Administrative Action issued in both circumstances, "Present an imminent danger to the health, safety, and welfare of the clients.” The North Carolina Family Policy Council applauds the Senate for taking decisive action on this matter, and we are extremely grateful to the House for already acting on the other very important provisions in this bill. We encourage you to concur with the Senate’s changes to House Bill 695. Thank you. [SPEAKER CHANGES] You’ll hear from Barbara Holt, North Carolina Right to Life. [SPEAKER CHANGES] Thank you, Mr. Chairman. I’m Barbara Holt, president of North Carolina Right to Life.And I appreciate the opportunity to speak to you today. North Carolina Right to Life supports the many pro-life provisions that are in House Bill 695 and because the committee has heard from these provisions discussed in previous committees and on the House floor, I’ll limit my remarks to Webcam Abortions. But before I do, I would just like to say that in all that's been said today, one of things that we have failed to remember is that abortion is never safe for the unborn child. In every abortion an unborn child dies. And so abortion is very different in that one particular way from every surgical and chemical procedure because we have the death of a living human being. In 2008, Planned Parenthood began with plans to expand to other states, Webcam Abortions. These internet abortions consists of a doctor in one city dispensing chemical abortion drugs like the RU-486 to women sitting in front of a monitor, at times many hundredths of miles away. Planned Parenthood the largest single provider of abortions in our country has plans to make dispensing abortion drugs like RU-486 a decision not definitely, definitely not between a woman and her doctor. Through April 2011, the FDA reported 2,207 adverse events related to RU-486, including 14 deaths, 612 hospitalizations, 58 ectopic pregnancies, 339 blood transfusions, and 256 cases of infections in the U.S. alone. Because of the serious complications associated with RU-486,the physician should be physically present when these drugs are administered and available afterwards in case something goes terribly wrong. This preserves the doctor-patient relationship and ensures a woman can see the doctor for help if she needs it. There are 13 states with laws prohibiting Webcam Abortions with Missouri on July 14th to be added to that list. I really urge this committee and the full House to concur with House Bill 695 and I ask you as you do to remember that you will be a voice for the voiceless. Thank you. [SPEAKER CHANGES] What I think we’ll try to do is take 3

Comments against the bill and there will go three comments for the bill and we'll see how much time we have left in that point. The names are being given are Beverly false, nen Emily Evert then Robin Allan. [SPEAKER CHANGES] Thank you Mr. Speaker I am Beverly Herrington false a retired obstetrician gynecologist currently living in durum in North Carolina. The first person I ever saw die was a 60 year old women who have pregnancy induced hypertension also known as pre clamps here or toxemia and for this reason it is H695 that needs to die. The best way to protect women's health and safety is to provide universal access to health care. The entire spectrum of health care. This decision must be left to the woman because it is her decision that affects both her life her family and the consequences of the outcome. I refer to you a 1994 article in title maternal morbid mortality related to induce abortion in North Carolina a historical study after the row versus way 1973 decision in the following 5 years maternal mortality dropped over 85% in North Carolina due to access to safe legal elective choice. The maternal mortality rate for North Carolina dropped in half as a consequence of access to safe legal choice. I refer you to February 17 2012 article morbidity and mortality weekly report published by Senates for disease control. This article documents a for forth increase in depth from a topic pregnancy. 13 women died in one year compare to 11 women in the entire previous decade. Access to health care is what will ensure safety for women of North Carolina. [SPEAKER CHANGES] Emily Evert. [SPEAKER CHANGES] Hello my name is Emily Evert. I was raised on the coasts of North Carolina but I moved ?? my husband who is in active duty military member station at fort Bragg. I am here to speak against house bill 695. I wanna tell my story. When I was 18 years old I was in a relationship with a man that was emotionally abusive. I found out that I was pregnant after six months into the relationship. I send all my information from. I was scared to tell my family I was even more scared to tell the man I was in a relationship with. I knew in my mind I couldn't raise a child especially one with a man that can go sentence without believing me. I decided that my best option was to choose abortion. I saw a wall maker on TV and admit that his intention for pushing house bill 695 was to eliminate access to save illegal abortion. I am here to stand for the women who have made this deeply personal decision like many women who have got illegal abortion in the state my story has a happy ending. I married to a great man who stands for North Carolina women and me. I have a beautiful three year old girl who is bright and healthy i have been able to follow my dreams and education all because I was able to plan and decide when I was ready to raise a child. I ask you to stand with me and all women of North Carolina who have the right to choose and plan their families in their own time. Please vote no on house bill 695. Thank you. [SPEAKER CHANGES] Robin Allan. [SPEAKER CHANGES] My name is Robin Holmes Allan and I thank you for the opportunity to speak. I think this bill is a travesty what this bill will do is limit access on the making.

To my way of thinking this has always been about access. History is telling us that abortions were killing women when it was illegal. It is my memory that doctors led the charge to help make abortions safe. Doctors were alarmed about women’s suffering from botched abortions and from the efforts of their own. In the early sixties when I was a very early teen maybe even pre-teen, I heard family elder’s discussing an abortion for my cousin. She was probably around fifteen. I knew what abortion was and although I couldn’t hear the discussion I could hear the angst in the room. They were taking her to New York. Abortion was not legal and finding a safe abortionist must have been a grave challenge. I have memories of volunteering at clinics to provide safe passage. After Roe V Wade, the ideologues would line the sidewalks all the way to the front door yelling hateful epithets and hurtful slogans. It was a horrific challenge to escort women to the front door. Then we got?? And the ideologues had to keep their distance. They still had their constitutional right to protest and they did and they have never stopped. Fast-forward to the early twenty-hundreds and I am volunteering at a clinic that provides reproductive health care. Women could drive up to behind the building or at least drive up to where they could park on the side. They were still out there with their bullhorns chastising women. When a police car arrived after a call about disturbing the peace their bull horns would disappear. Over time I worried that my car would be damaged. I worried that they knew my car and recognized me so I didn’t trust that my car would be safe. I asked my husband to drive me and pick me up. I tell you these stories for two reasons; it’s always about access. Even when women have a constitutional right, they will do everything they can to control women and their families. Those of you who support this bill have brought the street action inside our house, the house that belongs to the people. Women are watching. Women vote, and so do the men who stand beside us. [SPEAKER CHANGES] OK we will next hear from three people who are for the bill. In order, they will be; Dr. Marty McCaffrey, Dr. Greg Brannon and Wendy Banister [SPEAKER CHANGES] thank you for the opportunity to speak. My name is DR. Marty McCaffrey. I am a physician at the UNC school of medicine, I’m a neonatologist and I’m here today as a supporter of HB695. I’d like to address five points, five facts about abortion in North Carolina. Number one: abortion is a surgical procedure in 75% of cases in North Carolina. Two: abortion is one the most commonly performed surgeries in North Carolina. Three: abortion can cause bleeding, infection and death. Four: abortion clinics in North Carolina aren’t classified separately from all other clinics performing outpatient surgical procedures. And lastly, serious deficiencies have been reported in abortion clinics in North Carolina including ‘ employees performing ultrasounds after following physicians around to learn how to perform an ultrasound, medications provided without the written order of a physician, clinic emergency kits with expired medications, surgical instruments used on multiple patients without being sterilized. Dried blood observed on exam lights in procedure rooms, dead insects in windowsills and dirty ultrasound equipment, a physician rarely inspecting the products of conception. I once told an obstetrical colleague of mine that abortion is held to a lesser standard than that applied to all other interventions. I stated “we’ve placed abortions

Person on a pedestals occupied by no other medical or surgical procedure. She replied and that is how it should be. Abortion abdicates and their zeal to support abortion have advance their caused by creating an image of abortion that shields the public from reality of abortion including its short and long term medical risk placing abortion in this pedestals allow abortion providers to function with minimal Overside and let's reduces resulting clinic environment center properly staffed poorly equipped on senatorial dangerous. You lay on to back when streets regulate themselves nor does any other area of medicine provide Overside of its own operation. We are a society that takes steps in these directions with good reason. Regularly ensuring compline with minimal standards is today an expectation for health care organizations. Women considering abortion deserves the same insurance of an abortion clinics and hearance of basic medical standards as offered to a women undergoing a breast lung packing. The reality is that the abortion clinic which may be used by a women is not held to the same standard as the ambulatory surgery clinic which might perform her lung packing. The requirement the abortion clinic subjected to same ambulatory surgery centers demonstrates a commitment to women's health. It is simply good policy and I ask you to support HB695. Thank you. [SPEAKER CHANGES] Let's here from Dr. Grieg Brandon. [SPEAKER CHANGES] Mr. Chairman Dr. Brandon had to leave and deliver a baby. So we were wondering if Vialka Alan who is also on your list could have his spot. Sir surgical nurse. [SPEAKER CHANGES] That's fine. [SPEAKER CHANGES] It's okay. [SPEAKER CHANGES] Hi may name is Vialka Alan and I have 10 years’ operating women’s experience here in North Carolina at elements conque. Reason no medical center duke ambulance surgery center and also in California pacific medical centers in San Francisco. I currently work with group of six general surgeon. Most miss carriages also turn miss abortions require surgery. This is especially true the further along the pregnancy is. When surgery is required and OBGYNO take their patient to the OR weather at hospital or surgery center not his office. The surgeon should be present and should be qualified enough to perform the procedure correctly well trained support staff is vital anytime the uterus is handled there is risk of perforating resulting in Moran base of surgery. Any emergency in an office means any preformats to be called to transfer the patient to a hospital using the precious time. An anesthioligist should be present to manage the women and anesthetic medications air way breathing an vital science. Risk of retained tissue and poorly perform procedure can cause life for bleeding and infection. The women should be monitor closely for post-operative bleeding. How important is practicing sterol technique using a properly setup OR in a negative pressure room using properly sterilized insurance. Any procedure logically requires these step as well as the presence of qualified surgeon. Good care does not end in the OR by continues by proper follow up to promote the complete healing of the patient. The standard of care should not be different for the end of a wanted or an unwanted pregnancy. Women are not receiving the same standard of kid and addition clinic as they would in a surgery center or hospital. Well we do not condone abortion for any reason we recognize that while it is still legal we must provide the same care for all expecting mothers. The traffic and result is always the same which is the end of human baby's life but that the least we should take the same precautions as in missed abortion. I am asking you to please vote to conquer on each 695 that only because it will save precious unborn lives but because women deserve better than shortcuts and substandard care. Thank you for listening. God blesses. [SPEAKER CHANGES] Next will be Windy Banister. [SPEAKER CHANGES] Good morning. My name is Windy Banister I am the executive director of an organizational, local organization here in rally that provides pregnancy and sexual health related services and resources to the community. So tried to be executive director I was a senior director at one of our facilities here in rally for last three years. Last year I sent a sorrow of 850 women and men for pregnancy related services and additional 700 women and men for HIV STD testing.

we do possibly might be using this is just like Emily said the abortion decision is a difficult one for a woman, and so having all the necessary tools at hand precisely informed decision when my scares, then, is essential for health and well-being in a gossipy abortion tell you for any six hundred and make a few comments on clients that have come to Athens University that comments have been, that is a procedure that they would never achieve. if the abortion that happens at home University and something that I was ill-prepared that the cracking train the bleeding was excessive and much more than that I had been added to believe they are not adequately prepared to guide through a medical abortion of time I would access their abortion providers have to half assistance and support to the kind of love writing and experience one go with avoiding the weekends and was frightened and tried to coal facility and was not handled to raise anyone's health. I will help in that situation, follow-up appointments were nonexistent. back to the abortion provider takes procedure. these goals are not even aware that that was hot of the requirement by the anti- RU-486 studies where avoiding a friendly little organized doctor supervision unprepared without access to their abortion provider winning the unit that here's what we see today and I that when a woman cannot get access to old that will help back make an educated insight decision. we told in acts fifteen, when she's refuse all the education that will help them might excite decision had several health and well-being compromises are actually in control some of this old pieces to help her night had best toy automatic car that safely while having access to adequate ongoing care during the crisis and soaring that women are better protected and residents seeking abortions in North Carolina should be appointed by the size of distant thank you [SPEAKER CHANGES] table sipping her one more from each side against the bill are running marbling. [SPEAKER CHANGES] thank you, Mister chair, representatives, my name is Vicki Boyer, this past April. I had my sixtieth birthday, and subsequently I have realized that I had been hearing this discussion all my life when I was a child my family lives outside Washington, DC in the nineteen sixties, I was at that time, able to your Congress debate whether or not women. American women should have access to the birth control pill. the argument against it. women might regret their decisions. you can imagine how stunned I was just a few years ago, when Justice Kennedy wrote in the Supreme Court decision that throughout third trimester abortions that women might regret their decisions spoken as if no man ever suffered of regret on this bill doesn't effectively take away a woman's right to abortion in the state of North Carolina that has been the result in other states that have followed this line of legal pursuits. I think that if you really want women's health and safety the form is in your mind. then you fully, finally, DHHS, so that they have the resources and personnel in support system. they need to sort out all clinics that are not doing well and shut that clinic down instead of shutting down every clinic. I am apparent. I have had two doctors call it to live births. I had no drugs if any of those births all natural childbirth on what they used to call one tough cookie. this is my issue, and I will be following this issue for a long time, but as a parent as many of you are. we all want to raise our children to become positive, productive members of society we want them to find their skill or talent and use it to support themselves wisely. unless of course they are a woman you happens to be pregnant. suddenly she's relegated to a childlike status of a person who can't even capable of thinking

brain and she's a survivor Harney her mother times are stored on a C call for fathering concierge scenes us and zero in on seniors and timeouts and markets sell out one thing to fill injury is the findings and just say Julie time are those that have this mail is not the only CD ratings in one sheet for the designers are in that time was right to abortion is no hunting permits are visible at one of the realize it is just not the time is no enforces the women's brains and one triple play every one of the stains on downtime SS H underachievers and still think you were one more person file for the Belmont. When the center ?? and more inventive for the average instead of sitting here sharply on your side of the session timeout games begin: as I have tremendous interest in the morning that he knew, GM timers and similar material information to confirm have spent the season, when I saw stand back and systems and hearing from people time to ask Mr.(SPEAKER CHANGES) Why people are in demand regulations so there he is a genetically altering we were in the president's critics, at times has happened to me worried that there are very many restrictions corner, the time abortion clinics North Carolina citizens activities and realize how he'll make it was time to live as there are many complications of abortion the outpatient clinics and C are any issues from reactions in fact Simon & sons and can't think about why this resistance at the crease, Pierre franey endorsing open shot down over all ties the interest rate has makers, the lawyers financial lifetime, since access to the issue by you and financial rewards of a great site plan.(SPEAKER CHANGES) He confided forces a business point of fact, some layer to alter their clinics and into complaints that they're closer to surgical application clinics China ER and he has other incision to work that Marches to happen if he had worked at halftime and any other he's much as $465,000 a year veteran working on each morning so we said, before that's not so much talent at the dashing about how he gets a financial bind one time as the kingdom and that method. The press is something we currently are in prison, and only understands for these women or reject , and include sections was an exhibit forces she is and will spend the time included at the end of this as to where I have seen your train many of them are certain privacy, Tampico, diplomats convened this and this time that he sends us a little skeptical procedures and views or make up the rear of driving under his critics to-work of the game is Sunday morning as I could find happy that it will complication of the day when Thomas has a 65 visit: requires a hostile relationship of communication is probably 70 -satisfied and that it's even after winning basket-Contra DOS, the companies that combination has medicine and there has been using a hand-tinted windows, per times a thing existed at the long as the time things around thinking center in Boston. U.S. teams are in prison on his knees but I'm not afraid of the more you inserted questions in writing thinking things S setting off its one 16th and saucers and are in the 43rd we will discuss making changes to make sure time for all his teammates announced a new year begins, is now is now instead ?? …….

...safety of all the women in North Carolina. I am encouraged that we will concur, we will work together until then, thank you. [SPEAKER CHANGES] Representative Stevens. [SPEAKER CHANGES] Thank you, Mr. Chair. I wanted to agree along with Representative Samuelson, I was part of this earlier meeting. I am a mother. I am a woman. And I am a Republican. There’s not a war on us. We’re not having a war on you. My job here is as a state Representative to do what I think the people of my district want me to do. As a lawyer, I have the ability to do that with the legal logical mind. We recognize abortion is legal. We want to make sure it’s safe and healthy. We will try to work with the Senate because if we can do something there to go ahead and make it a concurrence as opposed to a non-concurrence and go to a conference report, if we can work with them on something that we can concur, it will certainly help expedite the process. It has been important to have this discussion today. It is important to hear from the Department of Health and Human Services. What I heard was that every clinic out there has had a violation in the last five to ten years. Maybe they’re not clear on the rules. That’s what the person from Durham said when they closed down the clinic, I didn’t know I was supposed to be testing this blood every day. The one in Charlotte breaking open a vial of IV medicine and giving it orally. Clearly we’ve got some problems and we need to set some standards and we need to be concerned about the safety and health about the patients who go there. I’m hoping we can continue to work and I’m certainly willing to do it. [SPEAKER CHANGES] Representative Insko, very briefly. [SPEAKER CHANGES] Very briefly, I would urge the Committee and the House not to concur on this bill and to look at providing access to increased inspection, especially follow up inspections for those clinics that have to make repairs. Thank you. [SPEAKER CHANGES] Thank you, to members of the committee and thank you to the public for your interest and attending and your input. This meeting is adjourned.