Testimony on House Bill 35 by Rep. Byron Cook
House State Affairs
March 8, 2017
Chair Cook and members of the committee, the Texas Medical Association appreciates the opportunity to present comments on behalf of our more than 50,000 members to voice our concerns on House Bill 35.
HB 35 directs the Health and Human Services Commission to adopt rules on disposal of embryonic and fetal remains. TMA’s members fall on both sides of the abortion debate so our comments today apply solely to concerns related to adopting legislation with the difficult goal of assuring appropriate disposal of embryonic and fetal tissue as proposed in HB 35. This issue is very complex — involving the very personal pregnancy experiences of thousands of families and also their physicians. Legislation in this area must involve communication and collaboration with physicians, health care facilities, and the public.
Application of the rules. Defining how to apply these requirements to which facilities is a challenge that will surely interfere with patient care and unfairly penalize medical practices or health care facilities. Thousands of pregnancies each year end because of spontaneous abortions or ectopic or molar pregnancies. Spontaneous abortions typically occur early in a pregnancy, sometimes before a woman knows she is pregnant. This can occur outside of a health care facility or in a physician’s office — yet these are not excluded in this legislation. Ectopic (pregnancy outside the womb) and molar pregnancies (when the placenta forms into an abnormal growth or tumor) must be treated immediately to preserve the life and health of the mother. Medically, there is no other treatment but removal. HB 35 would apply to embryonic and fetal tissue from these conditions.
The health or medical care provided to a pregnant woman by a physician can be broadly interpreted. And this legislation appears to include a variety of health care facilities such as clinics, federally qualified health centers, birthing centers, ambulatory surgical centers, and hospitals, and could include physicians’ offices where patients seek care following a spontaneous abortion. The scope of the facilities in the rules is broad, and the penalties are significant. It is essential that language regarding the pregnancy events and the facilities be clarified before being established in state law.
DSHS Registry. HB 35 requires the department to maintain a registry of funeral homes and cemeteries that are willing to be listed as providing low-cost or free burial services as well as other private organizations that offer to provide financial support for the costs of interment or cremation. Information from this registry will be available to a physician or health care facility as requested to assist with the cost of burial or cremation. It is unclear if this will require a conversation between a physician and their pregnant patients that includes a discussion about the possibility of fetal demise and the state requirements for disposition of embryonic and fetal tissue. If so, this would be yet another requirement directing the conversation between a physician and a patient on the patient’s care.
We understand your interest in offering options for women or families that experience a fetal demise or that seek an abortion. But physicians would need to be fully equipped to share accurate information, and we ask that you direct the department to develop materials and information for physicians and health care facilities so that we can answer the questions of our patients. We also recommend the state provide informational materials for the public on these requirements. This is particularly important as Texas has among the highest proportion of women in the U.S. who do not access early prenatal care as recommended. These women in particular should be targeted for information on what to do if they experience a pregnancy loss.
In conclusion, TMA has a long history of advocating on behalf of our patients and physicians on mandates that interfere in the patient-physician relationship. We are committed to open conversations rooted in science-based information as the foundation of the physician-patient relationship and informed decision-making for our patients — even when the state has failed to identify a compelling public health concern or threat.
We remain deeply concerned with efforts to legislate the actions of physicians. This is a precedent that would lay the foundation for future lawmakers to establish the details of the interaction between physicians and patients, and allow non-physicians to mandate what information, tests, or procedures must be provided to patients. TMA was founded with the mission of supporting the education of the public on medicine and public health. And we have worked for more than 150 years to promote sound public health policies to protect Texans. We look forward to working with the committee to address our concerns with HB 35.
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