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Senate | May 8, 2013 | Committee Room | Health

Full MP3 Audio File

Thank you members. So. We'll start by introducing our pages today. First we have Olivia Djaro. Durujo. Senator Paten thank you. Gabby Holmes. Senator Raven. Christine Marrow. Senator Jenkins. And Jordan Thomas. Senator Blue. We have a sgt at arms with us. If we don't know him by now we have problems. We'll rearrange we ask that senate 132 be moved to the end of todays calendar. So we'll go ahead and begin with senate bill 321. I do apologize for not being here but the insurance committee ran over. So I had to be over there. I was trying to dance between the two. Senator Davis is recognized to explain his bill. Do you have PCS. Senator Davis moves to hear the PCS senate bill 321. All those in favor say aye. PCS is before us. [SPEAKER CHANGES] Thank you chairman Heis and ladies and gentlemen of the committee. I bring to you today senate bill 321. Contain counties inmate medical cost. This legislation will provide to counties the same inmate medical cost that this general assembly enacted for the state prisons system several years ago. To control escalating state medical cost for state prisoners the general assembly enacted legislation to limit the department of public safety payments to medical providers to 70% of the current prevailing charge. That full non negotiated rate that no one pays except counties for jail inmate medical services. Unless our individual health insurance which is paid at negotiated rates. Counties are largely being charged that full non negotiated rack rate for medical services provided to county jail inmates. This legislation would implement the same medical cost containment cap for counties as that allowed for state prisons. I have had a conversation with representatives from the hospital association and they have some legitimate points of interest in this bill and I pledge to them that we will continue this conversation. It is in our best interest in every county. To make sure that the county is healthy but also that our hospitals remain healthy as well. And I'd be glad to entertain any questions that the committee may have. [SPEAKER CHANGES] Senator Kinnaird. [SPEAKER CHANGES] Thank you. I've just seen this now. And I've worked with for many years prisoner legal services and medical is always a problem both in huge cost over runs. But also there is a constitutional requirement that when a person is in custody that they have to have adequate medical services. When you put a cap on this and as I said I have not read this I just glanced at it. Are you not jeopardizing maybe a lawsuit even that says that they're not getting adequate medical services. [SPEAKER CHANGES] No we're not. They're still gonna get adequate medical services. This is not a bill about what level of medical services that you're gonna get. This a bill about compensation. The counties are just asking for the same thing, same deal that the state gets. [SPEAKER CHANGES] Senator Robinson. [SPEAKER CHANGES] Thank you mr chair. Thank you senator Davis. Two questions I am supportive of that because I know our county has had some issues in terms of covering the cost of medical care and this will help. But two questions, have you heard from the county's sheriff association. Well let me let you answer that in terms of hearing from the counties associations about this. Have you heard from them at all. [SPEAKER CHANGES] If I may mr chairmen. [SPEAKER CHANGES] Senator. [SPEAKER CHANGES] Are you referring to the sheriff's association or the North Carolina association of county commissioners. [SPEAKER CHANGES] County commissioners. [SPEAKER CHANGES] Yes I have. And they're in favor of this. [SPEAKER CHANGES] Ok [SPEAKER CHANGES] Matter of fact its been one of their goals for some time and I believe its one of their legislative goals for this session. [SPEAKER CHANGES] And the follow up Mr Chair. [SPEAKER CHANGES] Follow up. [SPEAKER CHANGES] My question is kind of in concert with senator Conard's question in terms of how does that putting the 70% cap on that. Because I know that our county has contracted with the prison health services before and that kind of thing. How does that affect their ability to provide those services or is there gonna be any impact based on that 70% cost? Of the usual and prevailing rate, I think thats what your legislation says. [SPEAKER CHANGES] If I may Mr chairman. [SPEAKER CHANGES] You may respond. [SPEAKER CHANGES] Yes it will impact their reimbursement rate the hospitals but it will not affect the level of service. Again I ...

mentioned earlier that the hospital association has been in contact with me about this bill, they would prefer to get a hundred percent, but wards of the county are just asking for the same rate that the state prison system is getting. But again, I don't believe there's any county commission in the state that would want to jeopordize the existence of their local hospital. And so we, I have pledged to them that we will continue a conversation so that we have everybody at the table to iron out the differences that we may have. [CHANGE SPEAKERS] I have Senator Rabin, and Senator Don Davis, and Senator Parmon, and Senator Bingham, so we'll begin with Senator Rabin. [CHANGE SPEAKERS] I'd just like to comment that I too, unsolicited, received calls today from some of the, my county commissioner. One of them who reports that the board of commissioners is a hundred percent on board, and therefore I'm saying at the appropriate time to move for a favorable report. [CHANGE SPEAKERS] Senator Don Davis. [CHANGE SPEAKERS] Thanks Mr. Chair. I would simply thank Senator Davis from the list here for bringing this forward. I think this would have tremendous impact on our counties. I just, right now our county, Greene county, in which I preside or reside, we have a situation right now dealing with paying a bill associated with an inmate had a heart condition. Unfortunately the inmate passed, and we're still trying to settle this debt obligation. I think this is more a stab at the long term here. [CHANGE SPEAKERS] Thank you Senator Davis. Senator Parmon. [CHANGE SPEAKERS] Thank you Mr. Chairman. I totally support this bill, and I've heard from my county commissioners. And having been a county commissioner and having to have dealt with issues like this, I certainly support the bill. But I also wanted to ask the bill's sponsor, within this bill is a requirement that the local jails have a procedure in place to ensure that indigent inmates receive the same quality care. Did you make sure that was covered in this bill? [CHANGE SPEAKERS] If I may, Mr. Chairman. [CHANGE SPEAKERS] You may respond. [CHANGE SPEAKERS] My understanding is that's federal law, and so those protections are there already. [CHANGE SPEAKERS] I wanted to re-emphasize that it is taken care of, and that we just need, that counties are able to pay these bills without going broke. Thank you. [CHANGE SPEAKERS] Senator Bingham. [CHANGE SPEAKERS] Thank you, Mr. Chairman. I was going to move for a favorable report, but I was in hopes that someone, Senator Davis from the hospital association may have a comment. I'm just curious, because I have two small hospitals in my area, and I agree with you as far as, but I just, I'm curious to how and what exactly in the direction and resolve in this, what effect it would have on some of these hospitals, the smaller ones. [CHANGE SPEAKERS] Anyone from the hospital association like to speak? Can you please identify yourself? [CHANGE SPEAKERS] Thank you Mr. Chairman. Hugh Tillson, Senior Vice-President, North Carolina Hospital Association. We've had a conversation with Senator Davis, the bill sponsor, about some of the issues we have related to this bill, and look forward to continuing to work with him. We're still trying to figure out, frankly, how this would affect some of those hospitals. Figuring out kind of how the payment rates would work, but also making sure that the custody questions are asked and answered. Make sure that we know who is really in custody, and therefore when a payment obligation kicks in, we recognize that these are longer term conversations, and we appreciate the bill sponsor's willingness to commit to having this with us. [CHANGE SPEAKERS] Thank you. Any other questions, comments? Seeing none, Senator Rabin have moved for a favorable report to the proposed committee substitute of the bill unfavorable as to the original bill. All those in favor say aye. Opposed no. The ayes have it. Thank you Senator Davis. Next we will hear Senator Cook. Drug testing for LTC applicants and employees. Check your microphone please, sir. [CHANGE SPEAKERS] Good morning. I believe there's an amendment to this bill. [CHANGE SPEAKERS] Member have an amendment? Senator Tarte. [CHANGE SPEAKERS] Yes. I have an amendment to offer. It's really a technical change.

him sorry narcotics Central recognizes one year minimum angular Change speaker:scare were really doing two things in this amendment one is the first is a clarification into sections also where clear that the adult care home will be paying for the day out screening an examination and the bottom. there's three reference points in the current bill that we're changing for consistency, the term testing just word are consistent using examination in screening Change speaker: questions are related to the amendment Change speaker: hearing on some doors, roof over his amendment to the adoption of the amendment. all those flavors they are opposed no gap is have it cynical correctness. Change speaker: thank you, as well as blood is designed to protect function adult care homes and nursing homes from drug-induced and complements other care providers, applicants for employment in these homes must pass a drug test as a condition of employment, and employees must pass random controlled substances testing as a condition of continued employment, five forty two provides protection so well liability for the home, officers and employees referred to employ people based on test results. health and human services and the Department of administration, said the bill has no physical impact, DHS, T, H H S already drug test. applicants were employed at the state operated long-term care facilities. most private nursing homes are currently drug screening employees. the bill was enthusiastically supported by the North Carolina Senior Tar Heel Legislature. I commend the bill to you. I know no objections. so I think Senator Cook, Senator forgot Change speaker:what is the Senior Tar Heel Legislature. it Change speaker: someplace and if you Google folks about my age were very concerned with how to set the autofocus use Senior got audibly on PC, God forbid, synergy lives. Change speaker:thank you, Mister Chairman noticed forgive Senator barefoot is not turned thirty one tomorrow so will a thirty five years they'll be contacting you to be a member Center cook who bears the cost of this drug tester. this drugs, Ukraine, Change speaker: the facility Change speaker:would you be amenable to an amendment that there requires the applicant to be responsible for the cost of the drug test and allow the facility him first. sometimes, Change speaker:we just passed an amendment to room to establish the facility management established on Change speaker:sorrow and was improperly hated seminar in any other members have questions or comments, and Change speaker:then Senator Raven will move for favorable reports the bills amended unfavorable window committee substitute unfavorables to the original bill, all those in favor placing promise I have pose no guys have it. thanks so that you and the family centered agency areas are Saturday to move Senate Bill one thirty two from Saturday to center temples and ran on a Saturday, notably recognized exponent development. I have two members

Two members of the community have asked to speak on the bill. [SPEAKER CHANGES] Marty McCaphrey [SP] will be joining Senator Daniel's in the explanation of the bill, from UNC hospital as well. Before we move to that we also have a PCS for this bill. Senator Tucker moves for the consideration of the PCS from the committee. All those in favor of considering the PCS please signify with saying aye. [SPEAKER CHANGES] Aye. [SPEAKER CHANGES] Opposed no. [SPEAKER CHANGES] The aye's have it, PCS is before us, Senator Danial. [SPEAKER CHANGES] Thank you Mr. Chairman and members of the committee. Basically just for the committee's information the only change in the PCS is to take the exact language that as in the original bill and relocate it in a place where we thought it was more appropriate in the educational curriculum so that it will be taught to students seventh grade and above. So that's the only change in the PCS. This bill is about giving our young people scientific information about the future health risks that are associated with abortion. It's a bill based on science, it's not based on political ideology. We educate our children on the risks of cigarette smoking, we educate our children on the risks of drinking and other hazardous behavior. And this is just a bill that's based on the scientific evidence that shows that you will have a future risk of premature birth if you decide voluntarily to have an abortion. At this time I guess I'll let my co-sponsor senator Randleman would like to say a few words and then we do have a gentleman from UNC hospital that's going to provide some expert testimony. [SPEAKER CHANGES] Thank you Senator Daniel. You know I'm very honored to have been asked to be on this piece of legislation. We talk about informing our young people and I think this is a step in that direction. And also I hope we will also cover today the impact that this has on families because when you have a preterm birth it devastates that family in a social way and also economically. So I hope that we touch on that also today, and as Senator Daniel says this is based on studies so I'm sure that we will have that covered and I hope that we can ask for your support. Thank you. [SPEAKER CHANGES] Good morning and thank you. Thank you for the invitation and the opportunity to speak in support of SP132. My name is Marty McCaphrey [SP]. I'm a neonatologist, professor of pediatrics at UNC Chapel Hill. Member of the North Carolina Child Fatality Task force and director of the prenatal quality collaborative of North Carolina, PQCNC or picnic [SP] for short. Former life I was a US navy captain, a medical director of a NICU and a navy surgeon general adviser for neonatology during my navy career. My work revolves around the care of premature infants but in picnic [SP] and the child fatality task force I've been fortunate to be involved in organizations whose missions include reducing prematurity and its consequences in North Carolina. Prematurity is a very complex problem with multiple associated risk factors. The 2006 institute of medicine, IOM report, is the comprehensive reference on factors associated with preterm birth. Including a prior preterm birth, infection, smoking and other factors. But the IOM report also identifies quote, " an immutable risk factor associated with preterm birth." Which is prior first trimester induced abortion. In 2006 there were 115 studies reporting on this association. Today there are 137 studies reporting on this association including two gold standard publications, systematic reviews with meta-analysis, the swingling [SP] and shaw [SP] studies. These dialysis reviewed 39 qualifying individual studies and reported and increased risk for future preterm, less than 37 weeks and very preterm birth, less than 32 weeks, of 36% risk and 65% elevation of risk after one abortion. Two abortions increases the risk for a preterm birth by 95%. There are no meta-analysis which dispute this relationship. Obstetrical experts are now openly acknowledging the evidence of the link. Dr. Jay Iams [SP], a maternal fetal medicine specialist, international expert on prematurity and member of the IOM preterm birth committee wrote in 2010 quote, " contrary to common belief, population based studies have found that elective pregnancy terminations in the first and second trimesters are associated with a very small but apparently very real increase in the risk of subsequent spontaneous preterm birth. Doctor...

Phil Street, obstetrician, editor of the British Journal of Obstetrics and Gynecology, commenting on the 2009 child study I referenced, wrote in his editorial: “The key finding is that compared to women with no history of termination, women with just one termination of pregnancy had an increase odds of subsequent preterm birth. We have known, listen to this, we have known for a long time that repeated terminations predisposed to early delivery in a subsequent pregnancy. I don’t think a lot of us knew that. I continue with Dr. Steer: “However the finding that even one termination can increase the risk of preterm birth means that we should continue to search for ways of making termination much less traumatic. How important is this for the citizens of North Carolina? It has been estimated that abortion may be responsible for 31% of their preterm births. In 2010 there were 2,100 very-low birth weight infants born in North Carolina. Abortion is estimated to be responsible for 262 of these cases, 86 excess deaths and 18 extra cases of cerebral palsy. The personal, social and emotional toll of this epidemic is staggering and disproportionately burdens the African American community. The financial impact however is equally devastating. In North Carolina in 2010 abortion related costs for hospitalization were $23 million with an additional $43 million in lifetime costs related to new cases of cerebral palsy in that given birth year. ??? reports showed a modest association at best between smoking and preterm birth in yet since 1985 have been labeled with “smoking by pregnant women may result in fetal injury, premature birth and low birth weight.” In North Carolina we have developed extensive public health campaigns to educate women of child bearing age about the risks of smoking and preterm birth but the evidence linking abortion with preterm birth dwarfs that linking smoking with preterm birth but the public is unaware. Some of the mothers of preterm babies I care for tortured at their bedsides as they maintained vigils with their preterm infants for months ask the question why, what could I have done to make this different. They know nothing about the association of preterm birth with the abortion they may have had months or years before. In summarizing the clinical implications of their landmark med analysis, Shaw stated: “ More than a million abortions are performed in the U.S. per year. Of these more than 75% of women wish to get pregnant again. These women should know the risks associated with abortion not only for their health but also for their future reproductive potential. Potential areas for knowledge, transfer, and this is still quoting Shaw from the British Journal article: “include education of girls and women enrolled in schools or colleges during routine visits to family doctors or specialists and finally in counseling women seeking abortion. Preterm birth has reached epidemic proportions in North Carolina. SB132 addresses a long overdue need to ensure that young women of child bearing age will be informed of all potential risks for preterm birth including abortion. At a point, hopefully, prior to making decisions which may profoundly impact their risk for a future preterm birth. It’s time to educate our young citizens about preterm birth including the fact that never having an abortion or deciding to not have another abortion reduces a woman’s risk for future pre-maturity in their birth processes. That is why SB132 is unanimously supported by the child fatality task force. I ask you to help put ??? like me out of business. Continue our journey to help make North Carolina the best place to be born and support SB132. Thank you very much. [SPEAKER CHANGES] Thank you…nothing else sir. We now hear from two members of the public we have signed up to speak, first Dr. David Grimes from UNC Hospital. [SPEAKER CHANGES] Good Morning. My name is David Grimes. I am a Gynecologist and Epidemiologist from the UNC School of Medicine and formally chief of the abortion surveillance branch of the CDC in Atlanta. I’ve been studying abortion safety for 40 years now and have published 135 articles on this topic in the ??? literature. Last month many of us were embarrassed to be North Carolinians. House joint resolution 494 opened the door to a state endorsed religion. This aberration immediately made national news. Although the resolution never progressed the damage had already been done. North Carolina had become a national laughing stock. Now a month later poised to go down the same path. SB132 would establish…

…by teaching that abortion causes pre-term birth. Have we learned nothing from our mistake last month? Three compelling reasons argue against this language. First, the statement is scientifically false. Second, the World Health Organization, the CDC, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics to which Dr. McCaffrey belongs, and the American Public Health Association all have uniformly concluded that abortion does not cause prematurity. How did they all get it wrong? Third, even if the statement were true, curriculum content should be left to educators, not politicians unfamiliar with the literature. If the Senate truly feels compelled to mandate health regulation messages, it should focus on tanning booths and texting while driving which pose real not imaginary health risks. Please don’t bring further embarrassment to our state through unnecessary and uninformed legislation. Thank you. [SPEAKER CHANGES] Thank you. Now I have Kaye Phillips. [SPEAKER CHANGES] Thank you Chairman Hise, Chairman Pate and committee members. Teen abortions and multiple abortions are rare in North Carolina. Thank you. Senate Bill 132 would require public schoolteachers to give students information on abortion and to tell them that three-plus abortions increase the likelihood of pre-term birth. It is important to recognize that abortion is rare among teenagers in our state. With fewer than nine percent of all teen girls receiving an abortion each year. Of those, 69 percent were ages 18 and 19. Furthermore only 4.6 percent of all abortions in the state were to a woman who had had three or more abortions. Teen behaviors that lead to pre-term birth already receive attention. Information on the most common causes of pre-term birth could help students make better decisions about their own health now and in the future, and the health curriculum should include those common causes, we do agree. Documented contributors to pre-term birth including unhealthy eating, lack of exercise and tobacco and alcohol use are prevalent among our North Carolina teens and are already addressed in the North Carolina Healthful Living Curriculum. Senate Bill 132 creates administrative roadblocks to required health education. It creates an administrative roadblock to providing health education requiring that any state-developed materials would require a 60-day review, LEAs, and an initial review period. It requires an annual update to the materials and the law inadvertently creates a two to four-month blackout. We understand the desire to reduce both the number of pre-term births and the number of abortions in North Carolina. Senate Bill 132 is unlikely to impact either health issue. It is however, likely to create discomfort for our state’s parents, students, and educators. Thank you very much. [SPEAKER CHANGES] Thank you. Senator Kinnaird. [SPEAKER CHANGES] Thank you. If I could ask Dr. McCaffrey to answer some questions. [SPEAKER CHANGES] OK. [SPEAKER CHANGES] Good morning Dr. McCaffrey. [SPEAKER CHANGES] Good morning, ma’am. [SPEAKER CHANGES] I have the privilege of serving on your… [SPEAKER CHANGES] Yes, you do. [SPEAKER CHANGES] …wonderful Picnic Advisory Committee and have learned a great deal. I have three questions, if I may, Mr. Chair. One of them that I learned from your committee was that one of the leading causes of pre-term births is planned deliveries less than full-term. Is that correct? [SPEAKER CHANGES] Yes, ma’am. There is an increase in the number of pre-term births that are associated with late pre-term deliveries and some of those you might say are planned, but they are later pre-term births for certain. [SPEAKER CHANGES] Second question. [SPEAKER CHANGES] Yes, I have three questions, this is the second one. Thank you Mr. Chair. Is this the only cause of prematurity? [SPEAKER CHANGES] No, ma’am. As I said it’s a very complex problem. So I would not stand up here and say…

abortion is the only cause of prematurity. I think that everything that was spoken about by the previous speaker, abortion comes closest to causality based on statistical analysis than any of those other factors do. But there are multiple factors that go into this. Speaker Changes: Further questions. Speaker changes: Further questions Mr. Chair, thank you. Speaker Changes: You did say very small, but you didn't give me actual figures or percentages. Speaker Changes: Jay Imes said very small. Are you referencing my quote that I used? Jay Imes who's one of the world's experts on prematurity and shared with the group at the Institute of Medicine report on the approach to prematurity has come out--even though he didn't say it at the time--has come out in 2010 now four years later and said, "There's a very real association although it appears to be small but very real, between abortion and prematurity. Speaker Changes: Senator Robinson? Speaker Changes: Thank you, Mr. Chair. I want to send forth an amendment. Speaker Changes: Member may send forth the amendment. Sergeant ?? will distribute copies. [pause] Senator Robinson is recognized to explain the amendment. Speaker Changes: Thank you, Mr. Chair. As you can see the amendment moves to amend the bill on page 1, line 31 by rewriting the line to read, simply, "Teaches about preventable causes of preterm birth, which would exclude the part about induced abortion." Just to explain that. I think what we've done, we've heard from experts on both sides of the aisle. And as any researcher knows, and I assume some of you are researchers, that you have multiple studies to validate your research. And you can continue to do that. You can prove, you can disprove, etc. What we've heard are things on both sides. I would say, and I've read about the ?? study, etc and what they said. Because they don't really have information to validate that the multiple preterm deliveries were causes of later problems or abortions. But I would say on the side of real people that I know for a fact in North Carolina infant mortality among low-income women--and I've heard somebody talk about minority and low income women--has decreased. North Carolina is one of the few states where it has and it's not because of teaching about preterm birth later leading to later abortion or whatever that is all that stuff you wanna talk about. But it's because of preventive health measures that are taught to women 15 to 44 in terms of your sexuality and your health. Now, what we want to do here is include another piece and legislation about what ought to be taught in schools by people who are not professionally educated to talk about abortion preterm delivery. As opposed to teaching what health educators are able to teach about sexually transmitted disease. If we teach kids about prevention, about the use of condoms, that it can not only prevent, has a high probability of preventing pregnancy, but it prevents sexually transmitted diseases like Gonorrhea, like Syphilis, like HIV and AIDS. If we would teach proper education we'd have a better chance of education our teens about these issues. We also heard one of the presenters say that most of those pregnancies had not occurred in women who were teens but older women. So that's the population I think that the doctor has an obligation to talk to their patients about. So my amendment here is to take that language out of here and if your intent is real, if your intent is real, in terms of properly educating our young people, then you won't object to this amendment. Speaker Changes: Thank you. Senator Barefoot. And we will leave individuals intent to individuals. Thank you.

I actually don't think that the amendment is a bad amendment. The amendment says teaches about the preventable causes of pre-term birth and the bill says the exact same thing. It just says that they must include induced abortion as one of the causes. I would like to correct a few things. I passed out to the members of the committee and this speaks directly to the amendment and some of Sen. Robinson's remarks. John Thorpe is a medical doctor at the University of North Carolina at Chapel Hill. He's also Holden's cousin. He is the professor of Maternal and Child Health at the School of Public Health. He's the Division Director for Women's Primary Health Care, the Vice Chair for Research for the UNC Department of OB-GYN. He sits on the editorial board for Obstetrics and Gynecological Survey. He sits on the editorial board for the British Journal of OB-GYN. He says in his letter, which you have, which does supports what Dr. McCaffrey stated. His last sentences says that given the fact that termination of pregnancy is one of the few modifiable risks --modifiable means that you can do something about it--risk factors for pre-term birth. The high number of women who have termination of pregnancy at some point in their lives and these women's almost universal desire to bare children in subsequent pregnancy. It is scientifically accurate and appropriate to educate young men and women about this modifiable consequence of termination of pregnancy. I would say that the nice woman who spoke against the bill; she indicated that the percentage of induced abortions that happens between women that are teenagers was 9%. What she did not include in that statistics is that 18 and 19-year olds are also teenagers and 18 and 19-year olds, as she stated, represent 69% of the women who obtain abortion. While your amendment does not go against the Child Fatality Task Force intent of educating young women on the preventable causes of pre-term birth, the bill is a little bit stronger and I'd ask you to vote against it. [SPEAKER CHANGES] Thank you. I will recognize Senator Robinson. I will ask all committee members to be aware of the time. We will conclude this discussion in four minutes. [SPEAKER CHANGES] Okay. Thank you, Mr. Chairman. Since Senator Barefoot is referencing my amendment, let me say there clearly that if you want to include abortion, you need to list everything else. Everything else. Unless you want to put a period there. The other thing you need to recognize, too, as we talk about those experts that you reference, I have my own too. There are experts all over the country and you need to recognize that. You heard another one and you can hear many more from CDC etcetera. I have extensive information from CDC, as a matter of fact, I provide some of this information in terms of health prevention. So, the information is out there. We can use whatever we want to justify why we want to do these things. I think that we need to make sure the health experts, the teachers, teach what they are able to teach and educated to teach; and not go into other areas that they are not professionally educated to do. [SPEAKER CHANGES] Senator Tucker, then Senator Davis, then we'll cut off. [SPEAKER CHANGES] Thank you, Mr. Chair. Very quickly. Can I ask the bill sponsor a question, Mr. Chair. [SPEAKER CHANGES] Yes, sir. [SPEAKER CHANGES] If this bill is passed will it stop -- excuse me -- the amendment is passed and we move forward with this, will that prevent the ability of people to teach about syphilis, gonorrhea, condoms, etcetera that Senator Robinson had discussed. If we move forward and remove all of this? [SPEAKER CHANGES] No, and thank you for the question. First of all, I'd like to ask the committee to vote against the amendment. It is a recommendation of the Child Fatality Task Force and to specifically address your question if you look in sub-paragraph “K”, I think that answers your question in current law that they already teach about preventing sexually transmitted diseases including HIV, AIDS and other communicable diseases. [SPEAKER CHANGES] Thank you, Mr. Chairman. I have a problem with this section “I” there and the cause of pre-term birth. I'm not acquainted with all the literature, but it appears as though induced abortions could be a risk factor, but that's different from being a cause.

And so for that. I'm struggling with this part of the bill because of that.[SPEAKER CHANGES] Could we have ?? address that.[SPEAKER CHANGES] We're gonna go ahead and vote on this amendment. We have 54 seconds. All those in favor of senator Robinson's amendment. Senator Robinson moves to amend the bill. Please signify by saying aye. Opposed no. The no's have it. Amendment fails. Moves for the vote on the bill. Senator Tarte moves that for approval on the bill[SPEAKER CHANGES]I have a question, I have a question on the underlining bill. [SPEAKER CHANGES] All those in favor [SPEAKER CHANGES] On the underlining bill I have a question. On the underlining bill I have a question, we just voted on [SPEAKER CHANGES] Senator Stein mark 30 seconds. [SPEAKER CHANGES] Thank you. So Bill Sponsor, do you agree that there are a number of risk factors that cause preventable pre term birth?[SPEAKER CHANGES] I would defer to the expert but I think that he indicated that there are more than one cause [SPEAKER CHANGES] Yes even your expert did that. So are you amendable to an amendment that would add the top five risk factors?[SPEAKER CHANGES] I think that's an amendment that I'm willing to consider. [SPEAKER CHANGES] Thank you senator ??. The clerk moves for the approval of the bill as amended by the post committee substitute not amended unfavorable to the original bill. All member signify by saying, proof of bills will signify by saying aye. Opposed no. The no's have it. Thank you this meeting stands adjourned.