 This is Senate Health and Welfare Committee, and we are continuing testimony on H57, an act relating to preserving the right to abortion. We've heard from a couple of folks, and today we're going to continue. And this, then on Friday, we will continue with additional testimony. And then there is, I know there's a person that I was supposed to be on the schedule today and cannot be on the schedule today. So I'm rescheduling her for next week. So that will basically be our line of testimony. So our first witness is Dr. Gibson, so why don't you come up? Thank you. Welcome. Thank you. Why don't we introduce ourselves once? You're going to be met in the comments. Nice to meet you. Jennings. Which question? Thank you for being here. I know that you are, have clinic coming up, or are in the middle of clinic, so I really appreciate your taking the time to be here. Do we have your testimony online? I don't know that I've sent this yet, but I can send it. We will get it. Yes, I'm happy to send it. Absolutely. Good morning, Chairperson Lyons and members of the Senate Committee on Health and Welfare. I am very grateful to all of you for the opportunity to be here today to show my support for Bill H-57, an act relating to preserving the right to abortion, which would codify abortion rights in Vermont law. My name is Dr. Erika Gibson, and I'm a pediatrician specializing in adolescent medicine at the University of Vermont Children's Hospital. In my day to day work, I am the director of adolescent medicine at UBMCH, where I see patients in the Adolescent Medicine Specialty Clinic, the Transgender Youth Program, at Woodside Juvenile Rehabilitation Facility, and on the Pediatric Hospital ward. I also have grant funding to work on a variety of adolescent health issues, including teen pregnancy prevention, prescription opioid abuse prevention, and adolescent well care. Previous to coming to Vermont, I worked at Columbia University Medical Center and New York Presbyterian Hospital in New York City, where I had appointments in both the Department of Pediatrics and in the Department of Population and Family Health at the Mailman School of Public Health. Today, I am speaking as a physician, as a member of the executive board of the Vermont Chapter of the American Academy of Pediatrics, and as a member of the Vermont Medical Society. As you may already know, the American Academy of Pediatrics and the Vermont Medical Society both strongly support minor's rights to confidential sexual and reproductive services, including abortion. Many other professional medical organizations also support access to confidential abortion care for minors, including the American Medical Association, the American College of Obstetricians and Gynecologists, the Society for Adolescent Health and Medicine, the American Public Health Association, and many others. I have spent the majority of my medical career focusing on adolescent sexual and reproductive healthcare, including prevention of unintended teen pregnancy and sexually transmitted infections. Access to safe and confidential abortion services has also been a part of that work. I believe that abortion is part of the full spectrum of reproductive healthcare, and it should be treated as the normal and common experience that it is. As you may already have heard, nationally, only 3% of abortion patients are 15 to 17 years old, and only 0.2% are under 15 years old. I come here before you today to describe how minor's rights to confidential sexual and reproductive healthcare, including abortion, are essential to the health and well-being of the young people that we care for. I feel that H57 should codify current practice with regard to abortion care in this state, and no changes should be made to the status quo. Confidentiality in adolescent and young adult healthcare is clinically essential, developmentally expected, and is an important element in protecting the health of individual young people and the public health. Decades of research have found that privacy protection encourages young people to seek essential healthcare and speak openly with healthcare providers. Likewise, other research shows that if patients are not assured confidentiality, they actually avoid seeking healthcare or involving trusted adults in decision-making. Many state and federal laws, as well as ethical guidelines, require confidentiality protection and support the rights of adolescents and young adults to receive confidential healthcare in certain situations, particularly related to sexual and reproductive health, mental health, and substance use. It should be noted that when agreeing to confidential healthcare services, a clinician needs to take into account whether a young person has the cognitive and emotional ability to understand the nature and risks of a proposed treatment, and is capable of making an informed and rational choice. It is ironic to note that in some states, pregnant and parenting teens are allowed to fully consent to their own care and care of their fetus or child while they are not allowed to make the confidential choice to choose an abortion if they desire to do so at the same age. While I routinely offer confidential healthcare to my patients as appropriate, the majority of young people that I care for do involve a trusted parent, guardian, or adult in sexual and reproductive healthcare decisions. We also know that most minors faced with an unplanned pregnancy will voluntarily disclose to a parent or a trusted adult. 61% of minors that have an abortion do so with at least one parent's knowledge, and younger teens are more likely to involve a parent. As clinicians caring for these young people, this is one of the first questions we ask them when they're faced with a challenging decision. What adults can you rely on for support in your decision making? How can we help you to communicate with them? What can we do to help? In terms of unplanned pregnancy, we know that every pregnancy is unique, and every individual's decision about their pregnancy is deeply personal. We also know that some young people do not live in supportive and functional home circumstances. They may choose not to involve parents in abortion decisions due to adverse home situations, including family trauma, instability, household substance abuse, or physical or sexual abuse. Many of the issues that we now recognize as adverse childhood experiences or ACEs. Young people may also choose to keep a decision about abortion confidential due to fear. Fear for their own safety. Fear of disappointing parents or damaging relationships with them. They may fear judgment, shame, or rejection. They may fear being forced to continue a pregnancy. In addition, some may not even feel close to you or live with their designated parent or guardian. While federal law guarantees a minor's rights to an abortion, in some states parental involvement laws require that a minor either notify a parent or guardian or obtain parental consent prior to obtaining an abortion. 40 years ago, the US Supreme Court ruled that there must be a waiver process available to minors who do not or cannot involve a parent in their abortion decision. A process known as judicial bypass. Recent research on the adolescent experience with judicial bypass reveals the following. Adolescents experience the bypass process as a form of punishment for their sexuality, pregnancy, and abortion decision. The process includes logistical burdens, unpredictability, and humiliation, resulting in traumatic experiences for some. This combined sense of punishment, humiliation, and internalization of abortion stigma can be associated with isolation, emotional suppression, long term psychological distress, and hesitancy to seek health care. Such a negative experience is highly consequential for adolescents going through a critical development period, particularly for adolescents that have little support from their own parents. It is particularly hard to understand why we would force a young person to go through the judicial bypass experience in light of the scientific evidence that there is no association between abortion and risk of depression, suicide, and other emotional harms. In summary, the majority of young women are capable of understanding the consequences of abortion and do not need state mandated parental involvement or judicial bypass to make the decisions that are right for them. Those of us that are experts in the field of adolescent medicine feel that most young women are mature enough to decide whether to carry a pregnancy or seek an abortion, and we know that most seek out advice on their own from parents or trusted adults. In addition, we feel that mandated parental notification, consent, or judicial bypass can actually be more harmful to an adolescent than seeking an abortion. I want to thank you, Senator Lyons, and the entire Vermont legislature for their commitment to protecting women's rights to reproductive health access here in our state. On behalf of my patients, the Vermont Chapter of the American Academy of Pediatrics, and the Vermont Medical Society, I respectfully ask the Vermont Senate to pass H57 to ensure that abortion rights and minors rights to confidential abortion services are protected here in Vermont. Thank you. Thank you. Questions? Question? Senator? Question? I don't know that we have any questions, but we certainly know where you are located. Yes. We do have questions. We'll get back to you. And what would be very helpful is to have your testimony for the record, and then we can access it on our iPad. I'll send it immediately. And don't drive too fast on the way back to the— It's a clinic. I will not. Okay. Thank you so much. Thank you. I appreciate the time you put into that. That wasn't—that's a lot of information. It will take some time to really digest all of it. Thank you. My pleasure. I feel it's very important. It's okay. All right. So, Bryn, we're not going to go to you. We're just here. Okay. That's good. Chloe White, ACLU. Good morning. Do we have—I haven't lost. Do we have yours online? Yes. And I didn't get to give you the representative. Hard copy. What I failed to say in the beginning is this. Senator Ingram is sick and Senator McCormick went to Representative Forgate's funeral. So, we are still— They're still quorum. And it's very important for us to have testimony so that they can also read it. Thank you for that. Good morning. I'm Chloe White. I am the policy director at the ACLU of Vermont. Madam Chair and committee members, I want to thank you for inviting us to speak on this important bill. We fully support it and we urge you to pass it out of committee. This bill safeguards the right to abortion and codifies what is already legal in the state. It ensures that at every point in a pregnancy, the health of the person is paramount and drives important personal medical decisions. Vermont has always followed and applied Roe v. Wade, which recognizes that abortion is included in the fundamental right to privacy. The future of Roe v. Wade and access to safe and legal reproductive care is under threat, however. Ours was made clear in Justice Kavanaugh's recent dissent in June Medical Services versus G, a case which could have closed nearly all abortion clinics in Louisiana and essentially dismantled Roe. In his dissent, Justice Kavanaugh effectively ignored the holding of whole women's health, the Heller set, which is a 2016 Supreme Court case that invalidated a Texas law similar to the one at issue in Louisiana and would have allowed a restrictive admitting privileges law to go into effect contrary to established precedent. It was only through Justice Roberts' fifth vote that the law was kept on hold, at least for now. Given the very real threat to reproductive liberty at the federal level, it is imperative that Vermont codify this right in state statute. This sort of legislation is not unprecedented. In 2017, Oregon passed the Reproductive Health Equity Act, which safeguards the right to abortion from interference by public entities, just as this bill does. Illinois is currently considering the Reproductive Health Act, which provides that every pregnant individual has a fundamental right to carry or terminate that pregnancy. At least nine states have statutes explicitly protecting the right to abortion, and Vermont should join these states and enshrine the protection in statute. In conclusion, I just want to again stress our full support for this bill, which simply creates a legal framework for what is already legal here in the state, but it is not codified yet in the state, and we believe that this codification is absolutely essential. This bill preserves the status quo and affirms Vermont's dedication to liberty and to privacy. We urge you to pass it, and thank you again for having me. I look forward to any questions you may have. Okay, thank you. So, questions? Thank you. Obviously, we had heard testimony previously on Proposition 5, so some of what we're going to hear is going to be repetitive, but the recent dissent, we didn't hear testimony about previously from Justice Katmaw, so that's helpful. Okay. Thank you very much. You're very welcome. Thank you. Sharon Toborg. Am I saying that correctly? Yes, you are. All right. Thank you. Thank you for being here. Thank you. For the record, my name is Sharon Toborg. I'm a policy analyst for the Vermont Right to Life Committee. Do we have yours? No, you don't. Well, we will get it. Yes, you will. Thank you. Yes. The committee is considering age 57 has focused largely on how abortion is currently practiced in this state. This is a mistake. What abortion providers say is current practice is different than what age 57 would allow. This legislation would allow unlimited, unregulated abortion throughout pregnancy and, very importantly, prohibits public entities from interfering with abortion. While abortion advocates have stated repeatedly that abortions done later in pregnancy are only done for reasons of fetal abnormality or maternal help, that is simply not true. And one need only look at the debate over the federal partial birth abortion ban act to know that this is not true. Partial birth abortion, also called intact dilation and extraction, or DNX, its supporters said was rarely used and only in the most extreme cases. Our Dr. Governor Howard Dean was on the national news saying there are most a few hundred such procedures being performed annually. Until a newspaper reporter went into her local abortion facility and asked. Ruth Padawer, a reporter for the Bergen New Jersey Record, interviewed physicians who used the method to reveal that at one clinic alone at least 1500 partial birth abortions were being performed each year. And only a, quote, minuscule amount were for medical reasons. Ron Fitzsimmons, the executive director of the National Coalition of Abortion Providers, admits he, quote, lied through his teeth, end quote, when he said on national television that partial birth abortions were used rarely and only on women whose lives were in danger or cases of fetal anomaly. Why the dishonesty? Because for the abortion rights movement, unrestricted abortion throughout pregnancy is not a philosophical problem. It is a public relations problem. Because when the truth comes out and the deception becomes clear, the people reject the unlimited abortion agenda. Congress voted to prohibit partial birth abortion in 2003. The legislation was supported by pro-life and pro-choice lawmakers. And even our own pro-choice Senator Patrick Leahy voted in favor of the ban. Planned Parenthood challenged the law that it was upheld by the U.S. Supreme Court in 2007. But the partial birth abortion ban act does not prohibit abortions later in pregnancy. It prohibits a specific type of procedure. So abortion practitioners perform later abortions still, but using other methods. And as legislators, you need to consider the full implications of age 57. There are those who would correctly point out that abortion has been legal throughout pregnancy in Vermont for decades. Yet we do not have the later in pregnancy abortion clinics that some other states have. However, by adopting age 57, the state would not only be legally embracing unrestricted, unlimited, unregulated abortion throughout pregnancy. The public entities section of the bill would remove the significant regulatory barriers that an abortionist would currently face if he chose to practice in Vermont. Age 57 declares that a public entity shall not restrict abortion access. What does that mean? An abortion facility could be exempted from the certificate of need process, Act 250, municipal zoning regulations. All of those barriers that legitimate businesses face when trying to set up shop in Vermont. Would violate age 57 if applied to an abortion business that wanted to come into our state? So when an abortionist like Kermit Gosnell or James Pendegrast or Robert Rowe or Stephen Brigham who have all faced charges in other states, loss of medical license for their involvement in illegal late term abortions, how the media describes it. But of course in Vermont we know there's no such thing as an illegal late term abortion. The state will have no legal recourse to prevent it, monitor the practice or intervene until even if women are injured and maybe not even until some women are killed. It is important to remember that the medical practice board and the office of professional regulation are public entities. And under age 57 would be prohibited from interfering with a provider's choice to do abortions. So when this debate was going on on the House side it was stated repeatedly that should an abortion practitioner try to do elective abortions later in pregnancy they would face repercussions from the medical practice board. That can't happen under age 57. And while most of the attention thus far has focused on the legal status of abortion, the testimony taken in the House Judiciary Committee confirms that age 57 will make significant changes to Vermont law. It will protect abortion above childbirth and will restrict pro-life free speech. Section 9497 prohibits a public entity from restricting access to abortion. It does not however prohibit restricting access to childbirth. Under age 57 individuals including abortion providers could have a right of action against the state. Should they be denied a certificate need for an abortion facility? Or as was suggested in House Judiciary, if the state tried to impose an across the board reduction in funding for healthcare programs that had an effect of reducing taxpayer funding for abortion they could have a right of action in that regard. Providers and recipients of other medical services would have no such right. And because many of the terms in the bill are vague and undefined it is unknown the full extent of the impact. Testimony in House Judiciary Committee confirmed however that schools as public entities would be affected by this legislation. It was suggested that pro-abortion messages in our schools would be protected while anti-abortion messages could be subject to restriction. So age 57 is not simply a codification of current abortion practice in Vermont. It is a far reaching bill intended to promote and protect abortion above other alternatives in our state. In her testimony in the House, Meagan Gallagher CEO of Planned Parenthood of Northern New England encouraged passage of age 57 claiming it represents the people of Vermont's position on abortion. In this committee it has been said that unlimited abortion represents Vermont's values. It does not. While most Vermonters consider themselves pro-choice, that does not mean they support unrestricted abortion throughout all nine months of pregnancy for individuals of any age as age 57 proposes. In a poll commissioned by Vermont Right to Life in 2000, 59% of Vermonters called themselves pro-choice, but only 11% said abortion should always be legal. 72% of Vermonters said excluding abortion, it should be a crime in Vermont for someone to hurt or kill an unborn child in the womb either intentionally or through negligence. 72% also supported requiring a physician or clinic to notify a parent before performing an abortion on a daughter who is under 18 years of age. While this polling data is from some years ago, a May 2018 Gallup poll also demonstrates that being pro-choice does not equal support for the full agenda of the abortion lobby. It found that 48% of Americans consider themselves pro-choice, but only 13% said abortion should be generally legal in the last three months of pregnancy. In 2011, the most recent year that Gallup asked the question, 71% of respondents supported a law requiring women under 18 to get parental consent, not just notification, for any abortion, even though 47% of respondents considered themselves pro-choice. Age 57 would prohibit abortion regulations and fetal homicide laws favored by Vermonters. We have to remember the abortion lobby calls nearly every regulation intended to protect the health and safety of women having abortions, interference with the right to choose. How would Vermont be able to protect women from abortion providers like Kermit Gosnell, who is currently in prison for killing two of his patients and murdering infants born alive? What tools would the state have to keep someone like him out of Vermont? Under age 57, the answer is none. Proponents of this bill have stated that it is important for the legislature to make it clear where they stand on abortion. And I agree. When the role is called on age 57, each and every legislator will go on record as being for or against unrestricted abortion throughout pregnancy, for or against a parent's right to know, for or against protecting abortion in a privileged place in our public policy. Will they declare by their votes that Vermont is indifferent to the health and safety of women seeking abortion, indifferent as to whether a viable, unborn baby is born or aborted, lives or dies? I hope not. And I'd be glad to take any questions. Thank you. Thank you. Obviously the first part of your discussion and testimony was about partial birth abortion, which in the bill we recognize that that state of federal law is recognized, so it's not really. Well, the first part of my testimony was about how the abortion lobby misleads the general public as to the circumstances and reasons behind later in pregnancy abortions. I understand that Vermont cannot supersede federal law with regard to partial birth abortion, but that is not the point I was trying to make. Okay, questions. Thank you very much. Thank you. Carrie Brown, Executive Director of the Vermont Commission on Women. Thank you for having me this morning. For the record, Carrie Brown, I'm the Executive Director of the Vermont Commission on Women. And I'm pleased to have the opportunity to speak with you today about the connection between access to reproductive health care, including abortion and women's economic security. We have a policy... Do we have your testimony? You do not have it. Not yet. Not yet. Yes. I wanted to make sure it was completely spick and span. So the Commission on Women has policy statements covering many different areas, and I'd like to read you our policy position on reproductive health care. The Vermont Commission on Women affirms that every woman has a natural and unalienable right to choose whether and when to bear children, the right to educational, medical, and counseling services to make that choice wisely, and the right to the appropriate support in order to create a secure economic future based on that choice. The ability to decide when and whether to have a child is one of the most important factors in a woman's economic well-being over the course of her lifetime. Having control over the timing of children allows women to increase their own education, make better investments in their early work and career choices, and create better outcomes for their children. Women's access to reproductive health care is tied to increased labor force participation, higher earnings, more advanced careers, and better financial conditions for their children and families. I'd like to speak a little bit about access to contraception in general. In the 1960s and 1970s, the introduction of oral contraceptives and repeal of laws restricting the sale of contraceptives in general, coupled with the expansion of funding for family planning programs, provided a significant increase in women's access to birth control. Looking back, it's possible to link this access years later to an increase in women's wages, their labor force participation, family incomes, and even their children's college completion rates. Children born after this access increased were 15% less likely to live in households receiving public assistance, and 4% less likely to live with a single parent. This access also contributed to an increase in the number of women employed in non-traditional and professional occupations and to higher occupational levels in general. Increased access to birth control can even be credited for helping to reduce the gender wage gap. One analysis showed that access to the birth control pill by younger unmarried women in the 1960s and 1970s increased their hourly earnings by 8% by the time they were 50 years old. The same analysis concluded that the pill can account for 10% of the reduction of the gender wage gap in the 1980s and 30% in the 1990s. And just as a side note, I will note that the Commission on Women has been tracking this wage gap over time for decades, and we really saw dramatic increases in the 70s and 80s and really kind of a leveling off from the 90s and on. And so that may be one of the reasons why we saw that kind of sharp increase in the past. Access to birth control is linked to increases in women's wages in their participation in the workforce and in their families' reliance on their earnings. While having a child at all does create both an immediate decrease in women's earnings and a long-term decrease in their lifetime earnings, delaying having a child can mitigate some of this loss. A delay allows time for investing in education and in early work experience, and women earn 3% more for each year they delay having children. Children whose mothers had access to birth control have higher family incomes, are less likely to live in poverty, and are more likely to go to college. And then looking specifically to a lack of access to abortion. The most common reason women give for seeking an abortion is that they aren't able to afford the cost of having a child. Low income women are particularly impacted by lack of access to abortion. They're over five times more likely to become pregnant unintentionally than higher income women, despite being sexually active at the same rates. Nationally, half the women seeking abortions have incomes below the federal poverty level, and three-quarters reported not having enough money to pay for basic living expenses. In one study, women who were unable to get the abortion they sought were almost four times as likely to have their household income fall below the federal poverty level, and were more likely to report not being able to cover basic living needs. Women who were denied an abortion were more likely to receive public assistance than those women who received abortions. Women denied abortions were more likely to end up in the future raising children alone in single-parent households than were women who received an abortion. And women denied an abortion have lower levels of full-time employment. And I'll just conclude with one additional finding from that study. Children born later to women who are able to get an abortion are more likely to live in households where there is enough money to pay for basic living expenses. Then children born because abortion was denied. Abortion denial also affects maternal bonding. Women are much more likely to report feeling trapped as a mother, resenting their baby, or wishing for the old days when they had no baby after abortion denial than with the next child born after receiving an abortion. They are. They're all foot-noted. So I'll make sure that you get a copy of this so you have the references. We can't accept just a blank statement without having some. Yeah, this is all research that's cited. No, thank you very much. It's great. Questions? Senator? Question? Thank you very much. Thank you for your time. Will you get the testimony to my email? I will send it right to her and then she can post it for you. Thank you. Thank you very much. Jessica, for our question. Hi. No, you said it right. All right. Thank you for being here. Yeah, good morning. Thank you for having me, Madam Chair, Senators. My name is Jessica Barquist and I am the new director of policy and organizing for the Vermont network against domestic and sexual violence. And I'm pleased to speak with you this morning in support of age 57. As Vermont's leading voice on domestic and sexual violence, the Vermont network works to promote policies that support victims and survivors of violence to thrive and live lives free from violence. There's a strong correlation between domestic and sexual violence and the reproductive health and well-being of women. Domestic and sexual abuse takes many forms, including physical violence and emotional, psychological, and financial abuse. Although victims and survivors may be both men and women and individuals of all races, identities, and ages, national data indicates that women are the greatest risk of violence from their intimate partners in their reproductive years. One important and often overlooked form of abuse is reproductive and sexual coercion. Reproductive and sexual coercion is a form of violence that involves behaviors intended to exert control over an intimate partner's reproductive health, including contraceptive use and pregnancy. Victims who experience reproductive and sexual coercion may experience their intimate partners using threat or violence to impact their access to contraception, forcing their partners to engage in sex or threatening to hurt a partner who does not agree to become pregnant. Several studies have documented a strong link between individuals experiencing violence and unintended pregnancies. Women with unintended pregnancies are four times more likely to experience intimate partner violence than women whose pregnancies were intended. In addition, it has been demonstrated that the prevalence of intimate partner violence is specifically higher for women seeking abortion services compared with women who desire to continue their pregnancies. Unfortunately, limiting or controlling a person's reproductive choice and agency is one way that abusive partners perpetuate involvement in victims' lives. It is very common for abusive partners to use pregnancy as a strategy to keep their partners in their lives and remain connected to them through children. Even if a relationship ends, abusive partners often use custody or other family court processes to harass, intimidate or control their former partners and co-parents of their child for decades. Victims encounter many barriers to leaving an abusive relationship, and victims' reproductive health should not be one of these barriers. It is essential that victims of domestic and sexual violence have full reproductive choice and autonomy. And for this reason, and those listed above, we strongly support age 57. Thank you so much. Thank you. So you took all of our more songs? Yes, I did. Questions? No questions? So, do we have yours? You said yes. We do. Yeah. Thank you. Yeah. And so, as I said, if we have further questions, we'll let you know. Great. Thank you very much. Thank you so much for being here. Garen Marshall. Garen, thank you for being here. I think you've come from New York. Yes, from Brooklyn. From all the way from Brooklyn. Yeah. We're glad. It's a short six-hour drive. It's fairly good weather. Okay. Yeah. So thank you for your testimony. I think I also have a New Yorker article written about what you're going to be presenting to us that I will share with the committee at some point. Okay. Great. Yes, my name is Garen Marshall. I'm, as you said, I'm from Brooklyn. I'm not here on behalf of any organization or anything. My wife and I are patient advocates, and we sort of just wanted to come, I wanted to come and share some perspective, patient perspective with regard to this bill. In 2016, my wife and I were going through our second pregnancy. Our first pregnancy ended in miscarriage at 10 weeks, which was heartbreaking because we very much wanted that pregnancy. And so we entered into the next pregnancy with a bit of hesitancy. But we were excited when we easily got pregnant again. Obviously, that's hard for some people. Early in the pregnancy, things seemed to be going fine. We passed that 10-week mark and we're very happy. And then we started to get some concerning indications from our doctors as the pregnancy progressed. So I won't go into all of the medical details, but there were just some little things that started happening. Nothing added up to anything particularly bad. But it looked like it might become a complicated pregnancy. So we removed to a high risk OB and started getting ultrasounds pretty regularly during the pregnancy. And like a lot of pregnancies, we were sort of hanging on to hope and just trying to get to a point where medical interventions could sort of swoop in if necessary. So we were sort of going in week after week and then at 30 weeks we went in and there was an excess of amniotic fluid. Our doctors explained that that meant that the fetus couldn't swallow and that indicated that it wouldn't be able to breathe outside the womb. And we were heartbroken because we very much wanted this pregnancy and had sort of been holding on, just sort of white-nuggling it that far. And that was the point that our doctor also informed us that they couldn't really help us beyond that. Our options were to continue the pregnancy and just sort of let what happened happen. Or we could, due to the law in New York at the time, we could leave the state and seek care outside of the state. But even though our doctors had the medical capability to help us, they, due to the law, could not. What was the law? So the law in New York at the time was, it actually was unconstitutional. It predated Roe and it wouldn't allow an abortion to be performed after 24 weeks unless there was an immediate threat to the life of the person. So in our case, even though the pregnancy was not viable and due to some other circumstances it was threatening my wife's health, those were not reasons that allowed them to provide care. So at that point we knew that we didn't want to continue the pregnancy because, like I said, it threatened my wife's health and the thought of continuing the pregnancy and maybe getting to the point where if born the baby would choke for a few moments and die just seemed terrible to us. So we sought a termination and that's when we found out that there's a handful of providers in the country that could take patients. At this point, after sort of getting some things together, we were at 32 weeks and we ended up having to borrow money from my mother-in-law. She took it out of her retirement account. A lot of these clinics don't take insurance really because they never get reimbursed so you sort of have to pay up front. We ended up, because of my wife's health situation, we ended up having to come up with $10,000 in about two weeks which is a lot. I don't know if it's a lot for everybody but it's a lot. And we had to quickly arrange flights in the hotel and rental car and everything and get to Colorado. And we had to get our doctors and the doctor there on the same page and it was pretty complicated. And we're middle-class people who had supportive family members. We were able to sort of get the money together. And ultimately we were able to get to Colorado and get the treatment that we needed. And came back to New York. So we went to Colorado and then came back and my wife was induced in a hospital in New York and she went through 30 hours of labor. Again, for a pregnancy that was not viable. So I think it's important to just, you know, the reason that I wanted to share that story is partly just to provide some patient perspective on what later abortions often are. There's a lot of rhetoric flying around about what abortions later in pregnancy are and why people get them. And, you know, they're always a complicated situation. It's not an easy procedure. It is not a frivolous thing that someone would enter into. It's not cheap currently. And the rhetoric that we're hearing about these procedures doesn't match patient experiences. Since going through our procedure and then working in New York and sharing our story to get the law there changed, we've met people from all over the country who have terminated later in pregnancy for a number of reasons. We've met with the providers that actually provide care, both the one that we went to and then a couple of other clinics. They're all incredibly nice people who are really trying to help people. It's important to note that the human body doesn't really follow legal timelines, right? That's why it's important for doctors to sort of be making the call instead of, frankly, you guys. New York changed its law after 50 years and I don't think we want to define health every 50 years. So it's important to sort of allow some vagarity that can be defined by doctors, I think. And that's why, you know, I think the law being proposed with age 57 is great. I think it's exactly what the law should be because it acknowledges that we can't draw meat lines around every person's situation. So if someone, you know, we've heard terrible stories about why people need this care. Many of them are for maternal or fetal health indications. Many of them are for very young people who have been raped or something like that and that does happen. In other cases, people have been pushed over an imaginary line by the law. They've been pushed over that line because they couldn't get the money together, they couldn't get access to care, all sorts of things. So I think it's important, you know, when you're talking about these things to really just hear from people affected by it or possible and hear from doctors and providers that are helping those patients. And just weigh whatever the law is against the actual experiences of the people getting the care. Not sort of these hypothetical situations that we keep hearing about. I'm more than happy to answer any questions you have. And I've sent testimony. We have your testimony. So one of the things you said, first of all, I want to thank you very much for being here again. I know it's not easy and I appreciate the stress that you and your wife have gone through in the whole process. I did read the article and it's a lot more antiseptic than the real life story. But you say now that you're working on behalf of patients and you're working with physicians, has your experience helped to inform the work of physicians in your own state or other states? Yeah, I think a lot of what we're trying to do is to make sure that people are considering patients and considering the sort of the full situation that patients are in. So I think that we are certainly now in New York trying to make people understand why the law is important, why the way in which the law changed is important and who it actually helps and it helps people like us and it helps, you know, I mean, we have a lot of patients in New York that we've met. I've looked for patients in Vermont so I could not drive here for six hours, but we haven't been able to sort of meet one. But I also know that they exist. They're probably scared to talk to you. They're scared to come out and talk to their friends and neighbors about what happened to them. And a lot of that is because, you know, we haven't created a compassionate space for people to share their stories. So I think that's really important, you know, let's say whether this law passes or not, but let's say that it passes. It's important to like make sure that we're having a compassionate conversation around it as it passes so that people understand why it's important and who it actually affects. And that's kind of what we're trying to do wherever possible. That's a very important message. Thank you for that. And do you now have children? Yes, we have a rambunctious two-year-old. Good one. Yeah. Who we, I mean, and that's the other thing, part of the reason that we were happy to be able to get the care we did was because, you know, my wife is safe and she was able to go on to have children. And that's one thing that, like, we need to make sure that when people need this care, they can get the care that it's safe, et cetera. And abortion is very, very safe. It's safer than, you know, I don't know. I'm sure someone could tell you. And so, yeah, we were very lucky. And we were lucky to be able to get the care. We're lucky now to have our two-year-old. So, yeah. Thank you. Thank you. Thank you very much. Safe driving. Thank you. Enjoy our stay while you're here. Oh, yeah, I went to school here, so. Oh, go ahead. I love Vermont. That's great. Which school? Bennington. Meagan Gallagher. Good morning. Good morning. Chairperson Lyons, Vice Chair Westman, and Senator Cummings. My name is Meagan Gallagher. I'm the president and CEO of Planned Parenthood of Northern New England, PPNNE. If role versus weight is overturned by the United States Supreme Court, the ability to access safe legal abortion will be determined by the states. The rights we've spent generations fighting for could disappear as soon as this year. And today I'm here on behalf of PPNNE to fully support age 57, which would protect access to abortion care in Vermont law. On behalf of our patients, we must keep abortion legal, safe, and free from restrictions. PPNNE is the largest reproductive health care and sexuality education provider in Northern New England, where we serve more than 45,000 patients each year across Vermont, New Hampshire, and Maine. Our mission is to provide, promote, and protect access to reproductive health care and sexuality education so that all people can make voluntary choices about their reproductive and sexual health. In Vermont there are 12 Planned Parenthood health centers and we provide health services to approximately 19,000 patients annually. Approximately 87% of our patients identify as women and 89% of them are under the age of 39. Patients come to Planned Parenthood for high quality, trauma-informed, non-judgmental, compassionate, and confidential care. In 2017, PPNNE provided contraception to 9,600 patients, nearly 4,800 pregnancy tests, nearly 2,500 cervical cancer screenings, more than 3,500 breast exams, more than 37,000 sexually transmitted infection tests, and approximately 1,100 abortions. The care we provide our patients is primary care and for many of our patients, PPNNE is their only health care provider. 10 of our 12 Vermont health centers participate in the Title X Federal Family Planning Program. Because of this participation, PPNNE is able to deliver care regardless of a patient's ability to pay. The decision to have an abortion is personal and the only person who is pregnant can decide what is best for them. All PPNNE health centers have compassionate, professional staff who provide accurate information and non-judgmental support. We're proud to provide confidential and expert health care to our patients because the outcome of a strong provider-patient relationship is simple, to make sure our patients get the care they need. In the past two years, the Trump administration has shown open hostility toward women's ability to access contraception and abortion. The administration has introduced policy measures that would allow employers to deny women birth control coverage in Dismantle Title X. The one program meant to assure that people with low incomes can still access birth control, STD testing and treatments, cancer screenings, and other essential health care. President Trump has also followed through on his campaign commitment to appoint justices to the United States Supreme Court only if they were reverse, row versus wade, the 1973 court decision that legalized abortion in this country. With the confirmations of justices Neil Gorsuch and Brett Kavanaugh, abortion rights are on the line. This year, 16 states have passed or are in the process of passing laws that would ban abortion at six weeks before many people know that they are pregnant. A PPN&E board member recently shared that a friend asked her if she would be arrested for having an abortion with the changes we've seen at the U.S. Supreme Court. This question is a reminder that many women of reproductive age do not know what their health care will look like if and likely when row versus wade is overturned. Vermont currently has no laws affirmatively protecting abortion rights. Given the threat to federal protection of these rights, it is important that the Vermont legislature make its and the people of Vermont's position on this issue clear this legislative session. That is what H57, an act relating to preserving the right to abortion would do. The bill proposes to recognize as a fundamental right the freedom of reproductive choice and to prohibit public entities from interfering with or restricting the right of an individual to terminate the individual's pregnancy. PPN&E firmly believes that each person is capable of and must be trusted to make their own health care decisions. The decision about one's pregnancy is up to the person who is pregnant and only that person. There are many factors that contribute to someone's decision to have a family or not and each of us deserves the right to assess those factors for ourselves. A person's ability to access safe and legal abortion when they need it is a critical component of their health and dignity as well as independence, freedom and equality. The ability to access contraception as well as safe and legal abortion allows women to participate fully in society. Many of the gains women have made in obtaining education, pursuing careers, moving closer to pay equity and in having greater determination over the timing and spacing of their children as we heard earlier from Carrie Brown are the direct result of increased access to birth control and abortion. According to the Pew Research Center, 70% of Vermonters support abortion rights. One in four women will have an abortion by the age of 45. In 2016, according to the Vermont Department of Health, there were nearly 1,300 abortions performed in Vermont. Abortion is a common, safe, medical procedure and we must protect its legal status in Vermont law. Planned Parenthood of Northern New England urges the Senate Committee on Health and Welfare to pass age 57 to ensure that reproductive freedom is protected in Vermont. We thank and fully support Vermont's Senate leadership for taking historic and common-sense actions to move this bill forward. I believe you do not have my testimony, but we will provide it by the end of the day. Oh, you do. Well, we didn't have the 16 states, but we have the rest of them. Indeed. That is current information. Wonderful. Thank you. And I'm happy to answer any questions. Any questions? And actually, it's a strange question, but I think it's one that sort of permeates the atmosphere. And that is kind of imperative for some people has such a bad name. Can you explain why that tarnish exists for your organization? Because of all the things that you're doing, I mean, you're providing contraception, you're providing family planning, you're providing just plain health care to both men and women, and yet people detract from the work that you do. And how does that make, what effect does that have on the organization and the work that you're doing? Thank you, Senator Alliance, for that question. The first thing I would do is clarify that while there are loud voices that oppose the work of Planned Parenthood, the reality is the majority of Americans are deeply supportive of Planned Parenthood in the work that we do. Here in northern New England, we have nearly 70% approval ratings. I think what you are speaking to is what a 95-year-old woman I met one day explained to me as the fact that a lie makes its way around the world while the truth is putting its shoes on. And the fact is that the incendiary language of our opposition is newsworthy in a headline-driven environment, and it catches people's attention, and it builds a rhetoric that is not grounded in the reality of people's lives. And so I think our work as Planned Parenthood is to bring facts and the reality of people's lives to this conversation, to support legislators in making policy that actually enables people to exercise their freedoms. Thank you. So we're going to move on to the Deputy Solicitor General. And then, Brenda, come up. We might have decided. Thank you. Good morning. Good morning. Do we? We don't. We don't have your testimony. We know that you will get it to why, right? Absolutely. For the record, Eleanor Spotswood, I am the Deputy Solicitor General at the Attorney General's office here in Vermont. So I was last before this committee testifying on Proposition 5, and I'd just like to take a moment at the outset to talk about some of the differences between age 57 and Proposition 5 and why it's important to pass both of these. As we've already heard this morning, the makeup of the U.S. Supreme Court has changed, and the court is expected to either dial back or abolish entirely its protection of reproductive rights, essentially at any moment. The amendment, the Constitutional Amendment, Proposition 5, which you've already passed, will take another three years to actually become law in Vermont. It's dependent on the next legislature. It's dependent on being passed by all the voters. So at the moment, it's not assured, obviously. The statute, like all the other statutes this body passes, can take effect immediately and is in the total control of this legislature. It's important to pass the statute now because the changes from the U.S. Supreme Court may come at any moment and not wait until the amendment is passed by the voters, which is unsure. Other key differences between the statute and the Constitutional Amendment. The statute is more specific than the Constitutional Amendment. It lays out, for example, specifics about the kinds of entities that it affects. It describes the private right of action. This is consistent with the differences between statutes and Constitutional Amendments that we talked about the last time that I was here. The Constitutional Amendments take a big picture view and the statute style into the specifics. Again, this makes sense because statutes are much easier to amend or repeal, as you know. This statute really creates the framework of sort of outlining reproductive rights in statute and future legislatures can build off the framework that you're making today. Just to remind the committee, the statute can't bind future legislatures. Again, they can change it at any time, but the Constitutional Amendment will bind future legislatures if it passes. Finally, on this point, the statute and the Constitutional Amendment, again, they work hand in hand. They work towards the same ends. Both are intended to protect reproductive rights. If and when the Constitutional Amendment finally passes, this statute will remain good law. It gives shape to the right that's in the Constitutional Amendment. It's sort of analogous to, if you think about the way our Constitution, both the state constitution and the federal constitution, protect against discrimination. Here in Vermont, we have the Common Benefits Clause. Federally, it's the Equal Protection Clause. Vermont still has specific anti-discrimination statutes. Even though we know that our Constitution protects against discrimination, we've still passed statutes to say, this thing here is illegal or protected by Vermont law as well as the Constitution. So, turning to the specifics in the statute itself, this bill codifies current practice in Vermont. Currently, as we've heard, decisions about abortion and other reproductive choices are private. They're between a doctor and a patient. But we don't have any statutes on the books that keeps this practice in place. We've relied until now on federal case law and the federal Constitution in decisions like Roe and Casey's. If we do nothing, the only way the current practice would change, no matter what happens to Roe v. Wade, would be if we passed a law that limited reproductive rights. I mean, nothing's in statute because there's been no movement by the legislature to limit. We've relied on federal law, but the only way things would change would be if we passed a law limiting rights. I guess one thing is, if Roe v. Wade goes away, would anything automatically change here? So, two answers to that question, and it's a very good question. The law in Vermont would not automatically change if Roe v. Wade went away. However, the practice in Vermont could change without the law changing. So one of the things that this statute does is it binds executive agencies and the state as an employer from discriminating against abortion or reproductive rights or abortion providers on the basis of their provision of abortion or on the basis of a patient receiving an abortion. So let me give you an example. Right now, if Roe v. Wade were overturned and this statute didn't pass, a new Secretary of Human Services could come in and say, you know what? We're pulling the licenses of all the abortion clinics and there's nothing in the law that will prevent me from doing that once Roe v. Wade is overturned. This statute would prevent that. It would prevent executive agencies from taking action against people who receive abortions or provide abortions. I would risk action given that the legislature has never taken action to close clinics. It's not like a Secretary that might have a little trouble with the legislature or the funding for his salary or something. It's an extreme example. But there has been no indication that Vermont legislatures are just waiting for something to happen on other states to overturn the productive. So I just want that clear. Even if you pass this statute, it won't prevent future legislatures from repealing it, as I say. But it will prevent executive agencies, municipalities, other arms of the government from doing anything. And like I said, the licensing is an extreme example. But doing anything like requiring multiple doctors to approve an abortion or a municipality deciding not to provide emergency services to an abortion clinic. But it has been alleged that this would put such clinics outside the reach of planning, zoning, certificate of need. That has been alleged. The Attorney General's Office disagrees with that interpretation of this law. Is there anything we can do to make that? I can remember having a similar discussion on gun shops. So we're dealing with what may someday be a constitutional right in this state. And I want to make sure that even though we protect the right, I don't know that we want to say you can just walk it anywhere without adequate septic provisions or water or water tests. Certainly. So let me clear up a few points about what this law doesn't do. It does not change the ability of the state to regulate medical professions, particularly through content neutral regulations that say, no, you have to check your water. You have to have medical licenses for anyone practicing medicine. You need to follow basic health and safety regulations. It does not change criminal law. So the example was brought up of the doctor in Pennsylvania who was killed a few of his patients. He was still against the law, even if you pass this law. It does not change tort law, including medical malpractice. So a patient would still have a right to sue a doctor who was practicing outside their license. It does not change, again, our licensing requirements. We can still require that abortion providers be licensed under the regulations of this state. It doesn't change federal law. The so-called partial birth abortion ban obviously is still in effect. Again, if issues arise with licensing or anything like that and this body wants to take action to pass future laws, it doesn't prevent you from doing that either. Does that clear up the question? The other comment that was made earlier was that schools would be able to promote abortion but not write to life issues. There would be a barrier to pre-speech should this go forward with the public entities included. What the law does is prevent schools from restricting access to abortion. So a school can't expel a student for getting an abortion. A school can't prevent a school nurse from counseling a student about abortion if that's within their practice. But it does not restrict the school or the school nurse's ability to also talk to the student about other options. Including right to life. Including abortion, I'm sorry, including adoption, carrying the pregnancy to term. Thank you for those questions. One other important thing to note about the difference between the statute and Prop 5 is that the statute recognizes fundamental rights including the right to choose a refused contraception or sterilization and the fundamental right to choose whether to carry your pregnancy to term to give birth or to have an abortion. It does not specify the standard of scrutiny whereas Prop 5 says that these rights will be subject to strict scrutiny. Strict scrutiny is the highest level of scrutiny that courts ever give government action. This says it's a fundamental right. Fundamental rights may get strict scrutiny or they may get a lesser standard of scrutiny. So this is actually one way in which the bill is slightly less specific than Prop 5. And it's just important to note that it doesn't spell this out but it can only be the same or less restrictive than what Prop 5 does. There's no way to make it more restrictive. It is also the Attorney General's position that this law is not ambiguous. It seems very clear about what it does but if a court were to have questions about whether or not this law is intended to change the current practice in Vermont the court could and would look first at Section 1 of the bill which is the legislative intent. Legislative intent spells out that Vermont currently does not restrict the right to abortion. The General Assembly intends this act to safeguard the existing rights to access reproductive health services in Vermont. And if there was any ambiguity in the law I believe that section would clarify for the court that it is not intended to change the current practice. And if the court wasn't satisfied with that which it should be it could look back at all of the testimony that you're taking now and the testimony that will happen in the floor debate and discern your intent from that. So could we say the current practice in Vermont we've heard there's medical ethics there's one federal law but that the current practice is not to allow late term abortions just for no reason yet abortion, later in pregnancy whatever the new term is. My understanding is that the current practice is to not legislatively restrict abortion access in Vermont and that's what this bill is intended to do that that is a decision that Vermont has left up to by doctor in a patient. But the counter has been that the medical code of ethics prevents just the abortion of a viable fetus without the mother's health and welfare being extended. The testimony was something about lying through the teeth and there's thousands of late term abortions for no reason other than I just decided I don't want to go through with it. I think that's what's causing some of the angst in the public is think most people or many people understand health, welfare of either the child or the mother but the thought of I just don't feel like it if you happen to think that women act like that is causing some angst. We've been told no you can't do that because doctors would use their license if they did it but that's the tension I'm feeling. So I hope I can answer your question. I can speak to the state of the law in Vermont. I am less familiar with the state of medical practice and I would defer to the medical society on that. The law in Vermont currently says unrestricted access. We do regulate medical professions of course. We do regulate clinics just like every clinic. But this legislature has never restricted. Have we ever said unrestricted access or we just... This legislature hasn't weighed in one layer or another. Correct. This law is intended to codify that. The blank slate. Essentially yes. The vision. Got to find the blank slate. It looks like this. If the blank slate were in place what would be different from what we currently have? Including will be weighted. Right. So in the near term this will not change anything. It will prevent future governments from taking action to discriminate against those who seek abortions or get abortions and those who provide abortions. Unless and until this body decides otherwise. But the Roe v. Wade talked about in part five talks about a compelling state interest. Roe v. Wade talks about if they said third trimester or late term. Whatever the term is. Roe v. Wade clarified too. Okay. But there is some recognition that the state might have an interest once you have a viable child in protecting that life along with the life of the mother. Things get more complicated at that point. And I think that's if what we're trying to do is reproduce Roe v. Wade which is the governing decision right now. I think just the public feedback I'm getting and I'm getting it from pro-choice liberal women that that's the concern that this is more wide that Roe v. Wade put some potential for state action. And I think prop five did. It's a high scrutiny. But it's there and this bill does not reflect that. I think I understand the concern. So Roe v. Wade was the initial decision that set out that women have a fundamental right to access abortion. That is what this bill says. There is a fundamental right. Roe v. Wade then went ahead and said because there's a fundamental right we're going to sort of lay out a framework for analyzing laws that restrict access to abortion. And it said in the first trimester no law can restrict access to abortion. In the second trimester there's a different the governmental interest at stake is a little bit different. And in the third trimester the governmental interest is even stronger. Except the states may. The states may. But do not have to. Yes. Important distinction. But all of that was under the rubric of a fundamental right. And the second takeaway from that decision was this is a fundamental right. But that doesn't mean that the state can never take action to affect it. So the state can still pass laws that affect the health and safety of the procedure for instance. So the way that the U.S. Supreme Court has analyzed this particular fundamental right has been changed over time. They've gotten, they've already sort of cut back on the protections of real versus weight. They've never said it's not a fundamental right. But they've shifted away from that trimester framework and they've adopted this undue burden standard of Casey. Planned Parenthood versus Casey. Family Services. Planned Parenthood versus Casey and now they say okay it's a fundamental right but the state can restrict it as long as it doesn't place an undue burden on the access to abortion. You with me so far. And it did not, it did away with the trimester framework. So that's an instance where the court said even though it's a fundamental right we're going to allow some more government interference here. In other contexts courts have found fundamental rights but have allowed even greater governmental interference. So for example in Loving versus Virginia and Obergefell versus Hodges the state said marriage is a fundamental right. Loving versus Virginia was the anti-miscegenation case where they said you can't restrict interracial marriage. So marriage as we know now is a fundamental right. You're still restricted all the time on the basis of age, incest, number you can only have one marriage and you still have to get a license to be married, right? So in other words courts have found that in certain cases even when there is a fundamental right governments can still restrict it. Now strict scrutiny is the absolute highest No this is from the governor am I going to go to a bill? So where were we? Back up a little bit. Certainly. So fundamental rights are not inviolable, right? We know that the government can take action to regulate fundamental rights in various ways depending on the right and the circumstances. So strict scrutiny which is in Proposition 5 is the absolute highest bar that the government would have to pass to restrict a fundamental right. It is the highest bar. This bill doesn't have strict scrutiny in it. So it could be less than strict scrutiny but you can't get more than strict scrutiny. Okay? Does that help? Keep going. We want to get all of your testimony. It's helpful to understand the legal issues around this because that's where it derives from. Legal issues is what I do. Let me just see what I've already covered and what I haven't. I actually think I've covered most of my major points so are there any other questions I can help you with? My question is do you get your testimony? I didn't know that was coming. It really will be very important for us to understand the issues that you've covered and you've heard the questions. I think they're very fundamental and important questions to all the members of the committee. Absolutely. Having your testimony is important. Yes. I do have one last question I think but I think that is prevalent in the Senate in the House and out in the real world not that this isn't the real world we're elected by the real world to be here as real people. I say that very seriously because I think sometimes people look at us and say that all we are is legislators but we represent a body of people who have put us here to make some really difficult decisions. The question I have is that will as some people propose will age 57 be caused harm? No. That's an important question to ask and to answer. I mean we asked that question with Prop 5 but Prop 5 goes out to the voters it's not our decision so it's a lot easier for us to support something that goes out to the voters but in this case it's something that is our decision and we want to assure ourselves that there are no unintended consequences and that it won't cause harm when and if it passes. To the extent that you are satisfied with the current state of practice in Vermont this will not change that so if you think that the current state of practice is not causing harm age 57 will not cause harm. Thank you. Our council has left us I was going to ask her to come back I think she might be back in just a minute we're going to take a break and then about a two minute break and then when Bryn here will put her in the seat and ask a couple of questions and then we'll go back to our committee for our next issue after a short break. It's been a long year. So you heard the conversation at the end and so it's not that I'm not asking for clarification right now but I think you've heard the questions especially those from Senator Cummings regarding age 57 brought 5 that the Solicitor General has brought to us the answers and so we'll be looking for a similar clarification in our committee from your perspective as our Ledge Council and then understanding what if any affect the Roe v. Wade no Roe v. Wade how it falls to the state what that means more testimony on Friday and the more testimony we take the more confused we get about what we're looking at so it will be extremely helpful for you we'll schedule some time for us to have a discussion so that's all I was going to say it's pointless you have questions and then the court cases that have existed I know the Casey Court case in Virginia was it reduces the scrutiny standard to another standard and what that means as time goes on so something of that would be helpful I'd be glad to put together some summaries of the relevant case law for you and then the more critical question I think as we've heard a lot of information today about what effect the bill might have in decision making by public entities in this state so some response to that what is a public entity so I know we're going to have additional testimony on Friday that will bring further questions so we'll look for your skills, information professionalism I will be there anything else? I would just say to you it would be helpful for me you've had some people in practice what is not the legal side because basically the law is silent there is no law there is no law so there is no law so when we talk about current practice in the law and this will continue from the legal side won't change anything that very much I accept is probably true what I don't get is the practice on the ground and what in law we said versus the practice of what is happening the medical practice around that so that was one of the people who we were supposed to have at least one, probably a couple more testimony from they were going to be here today so we'll get them in and I'll schedule some time so we can talk about that and I know that there are ethical guidelines that inform medical practice so we'll try and get some of that information because it's that medical practice that I would I'm most interested in supporting not changing and forwarding that okay we'll do that bring it to us that's actually the legal side but how you interpret legally what is the practical practice of what people would do is what I'm most interested in well and that was one of the reasons why Garin Marshall was here because of his own personal experience the patient experience that we don't hear about and as he said that people are very hesitant to speak about this it's hard to find people who are willing to do that and he's circling around to inform people like us so we'll see what we can get we'll do that anything else that you would like Senator? okay thank you we're going to take a break