An effort by an anti-abortion state senator to restrict state-funded abortions using state law, not a doctor's opinion, to define what is "medically necessary" was sharply challenged Wednesday during a legislative hearing.
Sen. John Coghill, R-Fairbanks, is the prime sponsor of Senate Bill 49 and chairman of the Senate Judiciary Committee, where the measure drew support from three out-of-state experts -- two doctors and a psychologist -- handpicked by Coghill.
Sen. Bill Wielechowski of Anchorage, the only Democrat on the Judiciary Committee, aggressively confronted all three, at one point asking the psychologist whether her research linking abortion to mental problems had been "decisively debunked."
In Alaska, the fight to restrict abortion has been raging for years. Coghill said Wednesday he's long been stymied by the bipartisan Senate coalition, which conservatives succeeded in dismantling after the November election. Now Republicans rule the Senate and House and he's in charge of Judiciary.
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"I wanted to get my side showing that I had thought through the health care issue," Coghill said. That's important because his bill isn't being heard by the Senate Health and Social Services Committee, Coghill said. Sen. Bert Stedman, R-Sitka and the newly tapped health panel chairman, is generally more interested in oil taxes than social causes and said he requested it not be sent to his committee.
Coghill said he's going to allow Planned Parenthood and the ACLU to testify on Monday and will invite public testimony as well.
His measure says that only serious physical problems -- not mental health issues -- should be grounds for medically necessary state-paid abortions. A woman suffering from mental or emotional problems could still pay for her own abortion, Coghill says.
If a woman is at serious risk of death or "impairment of a major bodily function" because of her pregnancy, the abortion would be considered medically necessary under the bill. Among the qualifying conditions are: heart failure, coma, sickle cell anemia, kidney infection, diabetes with severe organ damage, eclampsia (seizures related to pregnancy), and rupture of amniotic membranes.
Coghill's bill is a result of an Alaska Supreme Court ruling in 2001 that the state had to fund "medically necessary" abortions if it funded maternity care, to avoid discriminating among pregnant women who choose different paths.
Last year in Alaska, there were 1,629 abortions, two more than the year before, though generally the number has been shrinking, according to reports compiled by the Alaska Bureau of Vital Statistics. Some 581 abortions in 2012 were paid for by Medicaid, a drop of 42 from the year before.
Many of the state-paid abortions likely were elective, not medically necessary, Coghill's aide, Chad Hutchison, asserted to the committee.
He based that on a 2004 study examining why women have abortions. The study, by the Guttmacher Institute, a private New York-based research and education group that supports abortion rights, found that just 4 percent of the women listed their own physical health problem as their main reason, he said.
Hutchison didn't mention that 12 percent said physical problems were among the reasons or that 13 percent listed possible health problems with the fetus as a factor.
Coghill said he crafted the measure with the help of his experts and by reading the 2001 court decision. His bill has six co-sponsors including two of his five committee members. Sen. Lesil McGuire, R-Anchorage and another committee member, was silent during the hearing. When a reporter asked her view afterwards, she waved away the question and dashed off.
Psychologist Priscilla Coleman, a professor of human development and family studies at Bowling Green State University in Ohio, told the committee she has "published more peer-reviewed studies on abortion and mental health than any other researcher in the world" and frequently is called to testify because of her expertise. She said she has reviewed numerous studies by others as well.
She contended that "abortion is a substantial contributing factor" in mental health problems and called it a "risky choice" for women with mental issues.
"There is an abundance of literature documenting the association between abortion and declining mental health status," Coleman said, reading prepared remarks over the phone. "Therefore, I am of the opinion that abortion is never justified based on mental health grounds and abortion should not be paid for by the state of Alaska due to the presence of any form of mental illness in women."
Wielechowski was ready for her.
Didn't the Guttmacher Institute fault her research, with a written statement headlined "Study purporting to show link between abortion and mental health outcomes decisively debunked?" he asked.
"You're referring to one paper where there was an error that was corrected and the article stands," Coleman answered. She's published 37 abortion-related papers, including a "meta-analysis" reviewing many other studies, she said.
Guttmacher, and researchers at the University of California, San Francisco, said that her study failed to distinguish between mental problems that occurred before abortions and those that materialized afterwards.
"This was an abuse of the scientific process to reach conclusions that are not supported by the data," Julia Steinberg, an associate professor at the University of California, San Francisco, said in a March 2012 statement published on Guttmacher's Web site. And Coleman used her own flawed research in her meta-analysis of other studies, Guttmacher said.
Wielechowski also raised issues with Coghill's other experts.
He asked Susan Rutherford, a maternal-fetal medicine doctor at EvergreenHealth Medical Center in Washington, whether she had written a paper linking abortion to breast cancer.
No, she said.
Do you believe there's a link? he asked.
"You know there's some compelling evidence that it could be," Rutherford said. She mentioned a pro-choice breast cancer expert who found an increased risk, particularly for women who had abortions as teens.
That contradicts the National Cancer Institute, Wielechowski said.
There are flaws in medical literature, Rutherford responded.
She told the committee that kidney infections don't belong on the list of what justifies an abortion but said legislators may want to consider adding fetal abnormalities, because that is accepted in the medical community.
The third expert, John Thorp, is an obstetrician-gynecologist at the University of North Carolina in Chapel Hill who worked with Coghill's staff to come up with the list of serious health conditions that could justify an abortion.
Wielechowski pressed him on his views regarding requiring an ultrasound before an abortion, a controversial practice that pro-choice supporters say is intended to discourage a woman from going through with the procedure. Thorp said he believed an ultrasound should be done to check for complications.
Planned Parenthood Votes Northwest, the organization's political arm, raised concerns about the experts both before and after the hearing.
Asked about the credibility issues, Coghill said, "We could probably say the same thing about their experts."
In January, the state Department of Health and Social Services began requiring doctors to certify an abortion either was medically necessary, or was the result of rape or incest or a matter of the woman's life being in danger, in order to receive Medicaid payment.
But the new rule didn't define "medically necessary."