Human Services Committee
JOINT FAVORABLE REPORT
AN ACT CONCERNING COMPASSIONATE CARE FOR VICTIMS OF SEXUAL ASSAULT.
Joint Favorable to Floor
SPONSORS OF BILL:
Human Services Committee
REASONS FOR BILL:
To require all licensed health care facilities to provide emergency contraception to victims of sexual assault upon the request of such victims.
RESPONSE FROM ADMINISTRATION/AGENCY:
Secretary of the State Susan Bysiewicz testified: "It is timely that this Committee is debating the merits of compassionate care during a time when our General Assembly is in the midst of crafting proposals that would ensure health care access for our uninsured residents. Both of these public policy initiatives essentially share the same goal: ensure that our residents have access to health care that is badly needed.
". . . I firmly believe that women and girls who survive rape deserve nothing less than compassionate care. Compassionate care includes making sure that all rape survivors have the information and access to care and treatment that they need on site at the hospital that they turn to for help. This includes providing emergency contraception to prevent a pregnancy from rape.
"I have had the opportunity to speak with many victims of sexual assault as I introduced my initiative to establish an Address Confidentiality Program in my office. The trauma that these women and girls faced should not be further compounded by making the victim feel that she is asking for something that she does not deserve or by placing the burden on her to make sure that she goes to the right hospital for care. In the aftermath of a rape, victims suffer a whole host of emotions and placing barriers on their access to proper care will only belittle their experience and cause further stress and embarrassment. It is difficult enough for these women and girls to come forward and any additional obstacles they must face may cause them to hesitate or question themselves.
"The outstanding question is do we want our residents to have emergency treatment as soon as possible. This Committee and the General Assembly must answer this question in the coming months. The health care needs of the patient must come first in any emergency. Given that offering emergency contraception as soon as possible after rape is the medical standard of care for the nation's leading medical associations, Connecticut women and girls deserve no less.
"Providing emergency contraception at all of Connecticut's hospitals will not only ensure that rape victims are given the compassionate care and psychological relief they deserve, but will guarantee that they are not denied health care options based on where they live, the hospital to which they are taken, or the personal beliefs of the hospital or individual physician or nurse.
"I am very cognizant of how public policy affects ethical and religious beliefs of both the caregiver and the patient. Without question, the religious or moral beliefs of a caregiver cannot be allowed to obstruct a patient's access to care.
"In order to ensure that all hospitals provide compassionate care to victims of sexual assault, I support the provision of the bill that requires all hospitals that receive federal funds to provide the same standard of care. Not only should all publicly funded hospitals offer and provide it, the General Assembly should ensure that they do so".
Attorney General Richard Blumenthal, testified: "Emergency contraception drugs are prescribed to prevent pregnancy. A sexual assault victim taking the drug in the first 24 hours after a rape is 95% certain to avoid pregnancy. Time is critical. The drug declines in efficacy over time, and is significantly less effective 72 hours after the sexual assault.
"This medial safeguard is a victims' rights measure. No victim of a sexual assault should have to endure an unwanted pregnancy resulting from a barbaric criminal violation.
"In light of its extraordinary and enduring harm – physical and emotional—our state has rightly imposed tough penalties and we provide services to the victim of sexual assaults.
"This measure is simply another progressive step toward protecting victims of sexual assault from the horrific harm caused by rape.
"Referring sexual assault victims to another hospital is no answer to the need for prompt medical care. No woman should have to shuttle among hospitals at this time of pain and turmoil. Such referrals send a message that the hospital disapproves of such medical treatment. It impedes and inhibits use of effective measures to prevent a victim from becoming pregnant with the rapist's child. It may deepen the psychological as well as physical harm.
"Several other states including Massachusetts, New Jersey, New Mexico, New York and Washington require the same type of disclosure and dispensing of emergency contraceptives as is contained in Senate Bill 1343".
Comptroller Nancy Wyman testified: "Sexual assault victims need prompt medical attention. I believe it is vitally important that all legal prescriptions are available when a patient needs them. Emergency contraception is intended to prevent a pregnancy. The chance of a pregnancy resulting from a sexual assault can be greatly reduced if Plan B is administered to a victim within the first 24 hours following the assault.
"Female victims of a sexual assault should be treated with compassion during a time of trauma and pain. Plan B is available over the counter to adults, but we should ensure that everyone woman or girl knows that she can avoid the trauma of a pregnancy resulting from a sexual assault and that it will be provided upon request.
"My office with the assistance of Attorney General Blumenthal worked with Wal-Mart to make sure that Plan B would be available to woman in Connecticut when it was indicated that they did not intend on stocking the "Plan B" emergency contraception in all of their Connecticut stores.
"I felt strongly that Wal-Mart as a participant in the State's insurance network could not selectively choose which drugs to provide. I believed that if the arbitrary selection of what drugs to honor continued; the State would have no choice but to explore options to have Wal-Mart removed from the state network.
"I'm pleased that Wal-Mart recognized their responsibilities and worked with our office on "acceptable" contingency plans even in instances of "conscientious objection" by an employed pharmacist. A workable solution can and needs to be found.
"Our first priority as elected officials should always be to ensure that its participating providers make available necessary and appropriate treatment and services to all of our residents".
Representative Denise Merrill testified: "I support this legislation because it has become necessary for us to clarify state law regarding a standard of care for all women who seek emergency room treatment for any purpose, but especially in the wake of a sexual assault. Last year when this issue was raised in legislation, questions arose about the extent of the problem. Was there really refusal to provide emergency contraception at the state's hospitals? Which hospitals? Was it just the Catholic hospitals? (Some of which, in one particular archdiocese have now gone on record as explicitly stating that they will not administer this over-the-counter medication, even to a victim of rape in an emergency room setting.)
"Accordingly, a survey was conducted earlier this year to seek the answers. The survey results show that during the first six months of 2006, 40% of rape victims were not offered or did not receive the full dose of emergency contraception, 15 of these Hospitals being secular. Yet, according to the nation's leading medical associations, including the American College of Obstetrics and Gynecologists (ACOG), the American Medical Association (AMA), the American College of Emergency Physicians (ACEP) and the World Health Organization (WHO), offering emergency contraception as soon as possible after rape is the accepted medical standard of care throughout the country.
"This strongly supports the need for the legislation before you today. Accepted national standards of care indicate that emergency contraception is the safe, legal, prescribed standard of care for women who choose to avoid conceiving a child after being raped. Physicians and their patients, not hospitals, should determine appropriate treatment. This is especially true in an emergency situation, since women who are taken by ambulance to an emergency room do not have a choice of hospitals.
"The survey also shows clearly that this is not simply an issue of Catholic hospitals deciding on their own protocols, but rather a more widespread issue. Last year, some presented this as an issue of religious freedom of hospitals, citing the Catholic church's opposition to birth control medications of this kind as the objection.
"First, hospitals are not churches. In today's health care world, they are important public institutions, receiving a substantial amount of public funds to serve the public – all of the public. We are dependent on them to provide unbiased, high quality care – particularly emergency room care. Doctors must be allowed the full ability of their profession to prescribe whatever medication or procedure is medically necessary or desired under a strict protocol for all medical situations. The women of Connecticut should expect that when they enter a hospital they are being provided with all legal healthcare options, especially during such a medically sensitive time as in the wake of a sexual (and potentially dangerous physical) assault.
"It has been suggested that hospitals that refuse to follow the standard of care based on religious concerns should be able to do so, but that they should then opt out of public funding. I do not support this idea, because I know that we need all of our hospitals to perform at a high level. They are a critical part of the public infrastructure for health care in this state. But they must provide care for all who come, and not let the religious beliefs of their Board members control medical treatment.
"Emergency contraception is nothing short of a modern miracle, one that provides benefits to victims of rape, one of society's most heinous crimes, that can't be overstated. What more terrible thing can any of us imagine than to become impregnated by one's assailant! These women have a right to safe, legal medications if they decide to take them.
"Please support SB 1343, An Act Concerning Compassionate Care for Victims of Sexual Assault so that we can be assured that victims of rape have every opportunity to avoid the potential lifelong consequences of such a heinous attack".
Teresa C. Younger, the Executive Director of the Permanent Commission on the Status of Women testified: "At the PCSW, we have worked for many years to promote full access to comprehensive health care for women, and to protect the needs and rights of women who are victims of sexual assault and domestic violence. The bill before you today is about these two important issues – health care and the rights of crime victims - nothing less and nothing more.
"According to the American Public Health Association, more than 600,000 women are raped in this country every year, and approximately 25,000 become pregnant as a result. Pregnancy could have been prevented for as many as 22,000 of these women by the prompt and timely use of emergency contraception
"According to the Connecticut Sexual Assault Crisis Services, nearly 400 women were accompanied to hospital emergency rooms last year in Connecticut for treatment and evidence collection following a rape. (The total number of victims of sexual assault who sought treatment in hospital emergency rooms is higher, as this number represents only those who sought assistance from a rape crisis center.) Every single one of these victims of violent crime is entitled to complete, caring and thorough health care, no matter the time of day or night, and no matter where the police car, ambulance or loved one brings her. And every one of these victims of rape is entitled to the best possible chance to avoid becoming pregnant if she chooses.
"Emergency contraception is safe and extremely effective when taken within 72 hours of unprotected sexual intercourse. It is approved by the Food and Drug Administration, and recommended as the standard method of care for sexual assault survivors by the American Medical Association, the American College of Emergency Physicians, the American College of Obstetricians and Gynecologists, and the World Health Organization2.
"S.B. 1343 would require all licensed health care facilities that provide emergency treatment for victims of sexual assault to follow the standard of care and provide medically and factually accurate information about emergency contraception and to dispense emergency contraception when requested by the victim. Six other states currently have similar requirements, including New York, New Jersey and Massachusetts. Providing this standard of care will ensure medical care and psychological relief to rape victims, which they deserve without question.
"If we imagine the circumstances of a rape victim who arrives at an emergency room for care and evidence collection, it is not hard to understand why this is so critical. The rape victim might arrive at the hospital ER in the middle of the night; she might be badly hurt or even unconscious; she might have been given drugs by the perpetrator of the assault; she might have injuries but have been too embarrassed or frightened to tell the police or whoever is assisting her that she was raped. Once she arrives at the ER and informs a health care professional that she was sexually assaulted, she will not only receive treatment and care, but will also be subjected to procedures for evidence collection that are so invasive and unpleasant that many women refer to the process as a second rape. Under these circumstances, a simple course of pills, taken promptly can prevent any pregnancy from occurring in large majority of cases. Health care providers are obligated to put the needs of their patients – in these cases the victims of a violent crime – first, and to meet the standard of care in treating them.
"Opponents of this bill may confuse emergency contraception with abortion. As the APHA explains, 'Emergency contraception has no effect on an established pregnancy and cannot dislodge an implanted embryo.'3 In fact, emergency contraception prevents abortion by preventing unwanted pregnancy.
"Opponents of this bill may also say that it does not protect religious freedom. But this bill does exactly that – it protects the religious freedom of the patient who is a victim of rape. Patients must be able to make treatment decisions based on their own ethical or religious beliefs. The religious or moral beliefs of a caregiver cannot be allowed to obstruct a patient's access to care. It is unfair and increases the medical risk for rape victims to require them to wait or travel to a second hospital emergency room after they have been assaulted. Very few victims of rape will stop and consider whether the closest hospital will restrict their health care or provide them less than the standard of care – nor should they have to add that worry in the aftermath of a violent crime.
Representative Mary M. Mushinsky testified: "I am in support of this bill, with a recommended amendment. This issue here is a conflict between sincere religious precept and a sincere desire to assist innocent rape victims. The legislature's job is to resolve this conflict in a respectful manner. My recommendation is to waive the religious hospitals from the dispensation requirement of lines 35-36, on condition that the requirement for on-site provision of emergency contraception is met by another provider.
"In line 36, after victim, strike the period and insert: , provided no health care facility shall be forced to dispense emergency contraception in violation of its religious precepts, and such facility shall not interfere with on-site provision of emergency contraception to such victim of sexual assault by a provider not employed by the health care facility.
"This amendment respects religious precept while also respecting the rape victim who needs immediate care and wished to prevent rape-caused pregnancy."
Representative Deborah Heinrich testified in support of SB 1343
Senate Minority Leader Louis C. DeLuca testified in opposition to SB 1343
NATURE AND SOURCES OF SUPPORT:
Angie Wright, a graduate student at the University of Connecticut School of Social Work, testified: "The tragic contribution of rape to the problem of unintended pregnancy has received relatively little public health attention despite the fact that sexual assault and rape are significant social and health problems in the United States.
"In January 2006, the U.S. Department of Justice, Office of Justice Programs, highlighted the results of the 1995/96 National Violence Against Women Survey (NVAWS), a nationally representative survey conducted to measure the extent of violence against women. Results indicate that 301,091 women had been forcibly raped in the year preceding the Survey, and that 17.6% of surveyed women were raped at some time in their lives. Thus, in the U.S., 1 of every 6 women has been raped at some time in her life.
"While statistics about sexual violence vary due to differences in how it is defined and how data is collected, the Centers for Disease Control (CDC) emphasize that available data greatly underestimates the true magnitude of the problem.
"Researchers also estimate that the national rape-related pregnancy rate is 5% among victims of reproductive age (aged 12-45), and while this may account for only a relatively small portion of unintended pregnancies occurring in the U.S., it still represents a significant number.
". . . Public policy should encourage rape victims to seek assistance; it should not discourage them.
"Pregnancy following rape could potentially be reduced by approximately 90% if all women had access to Emergency Contraception (EC) following sexual assault. Offering Emergency Contraception as quickly as possible after rape is considered the medical standard of care by the American College of Obstetrics and Gynecology, the American Medical Association, the American College of Emergency Physicians, the US Centers for Disease Control, and the World Health Organization.
"One objection to providing Emergency Contraception is the concern that women who know that they can use EC may become less diligent with their ongoing contraceptive method. However, there is considerable evidence that Emergency Contraception does not increase risk taking, and that women who are the most diligent about ongoing contraceptive use are those most likely to seek emergency treatment.
"Furthermore, Emergency Contraception is nearly always cost effective. Emergency Contraception reduces expenditures on medical care by preventing unintended pregnancies, which are very costly. Yet, this is more than an issue of economics and the expenditure of health care dollars. There are additional social cost savings as well, and these include the considerable psychological costs of truly painful unintended pregnancy.
"As a matter of human dignity . . . victims of sexual assault should be able to access complete medical care no matter what hospital they turn to after being attacked.
"I urge you to require that every licensed health care facility providing emergency medical services within the State follow the medical standard of care for treating sexual assault victims. Victims of sexual assault, who are members of our families and our communities, deserve, and should have, the moral agency and legal options embedded in Raised Bill No. 1343".
Rod O'Connor, testified: "Last year when I testified before the Public Health Committee on providing emergency contraception to victims of rape in all rape trauma centers across the state, I was na´ve. I believed that once all the personal stories, the facts and statistics had been laid out, that no one could oppose the sensible solution of allowing all women who have been raped the option of emergency contraception at the point of her first entry into the medical system.
"I am no longer na´ve, I'm just angry. I shouldn't have to be here before you to testify because rape is still a crime of violence. Rape is not about sex. Rape is not about reproduction. Rape is violence against women. If anyone withholds any form of treatment from a victim of a violent crime, they should be held accountable.
"No woman who has been raped should be forced to wait until she can see another medical professional to prescribe emergency contraception. No woman who has been raped should be forced to look for an all night pharmacy or wait until her neighborhood drug store opens. No woman should ever have to bear a rapist's child.
"Last year I used my friend Anne's experience as a victim of rape as the basis for my testimony. This year I asked Anne if she could write testimony to submit to the Human Services Committee. . . .She still cannot mention her rape to even close friends, much less curious parishioners.
"Every woman who is a rape victim deserves the most compassionate, effective and complete care at the earliest possible time in her journey to recovery. In every case, this should include the option of emergency contraception".
Anne, testified: "I am a survivor of rape. In October of 1993, when I was 27 years old, a man broke into the apartment in the middle of the night. He tied me up and raped me at knife-point. He was never caught.
I've been told that the average rape lasts 20 minutes. That's not a long time. But the impact of those twenty minutes is harsh and deep. For the first few years after the rape, my life was sliced cleanly in two: a before and an after, separated by a wide chasm. The territory of "after" was a whole new landscape for me.
In 1993, I was an elementary school teacher. I had never had sex. I was not dating anyone. . . . I did not tell my parents about the rape until more than a year after it happened. I needed time to make sure that I would be able to take care of myself and of them when I told them.
The police who came in response to my call the night of the rape were gentle and kind and extremely uncomfortable. All of them were male, and it was to them that I had to repeat all of the vile things the rapist had said to me—using words I'd never spoken before in my life. My 13-year-old cat ran away that night because the intruder had left the door open. I could hear him crying outside but he wouldn't come in, and I had to go to the hospital.
The hospital had a rape kit which is used to gather evidence. The doctor cut off strands of my hair, scraped under my nails, swabbed for fluids. All of my clothes were kept for evidence. I spent much of the morning at the police station working with a sketch artist. Although I'd seen the man's face, I couldn't remember it clearly. I thought maybe he was Latino—and then I worried that perhaps he wasn't Latino at all and that I was harboring some terrible prejudice. It was hard to think clearly—about anything.
When I finally got home, my landlady was there. Someone had called her, and she knew only that my apartment had been broken into. She came to my door and asked me, "Were you home?" When I said yes, she asked, "Did he touch you?" Later in the day, a man she had hired to do custodial work came to the house and cried when he saw me.
The day of the rape was the first of many days during which I was terrified to be home alone. I stayed with friends, or friends stayed with me. For the first few nights I didn't sleep at all, and for a long time I slept fitfully. Eventually a doctor prescribed valium to help me sleep. My teaching colleagues subbed for me for a week while I tried to collect myself. When I returned to school I found that I was completely sapped of creativity.
In the first few weeks and months after the attack, I filled out a jarring victim/witness compensation form (twice!—because of statewide administrative changes) so that I could be reimbursed for the costs of therapy relating to my experience. I searched for a new apartment until I finally realized that I was too afraid to live alone, and then I moved in with a friend. I battled with my insurance company, which initially refused to pay for my hospital bill because I hadn't called my doctor before going to the emergency room. I went for an AIDS test and didn't know answers to the most basic questions: Does your partner have AIDS? How many partners has he had? Does he ever do drugs? I fielded questions from the police as the investigation stretched on. Every time I called the station I had to identify myself again as a rape victim. I lost weight. I had bad dreams. I had been considering becoming an ordained minister, and I withdrew my name from the official list of candidates. I met with my therapist every week, and it was months before I could bring myself to tell him any details of the attack.
What if the rape had left me pregnant? What would I have done? I don't know. I can't imagine. Every task, every interaction felt overwhelming to me. How would I have dealt with pregnancy on top of everything else? For a very long time, just making it to the end of the day took every ounce of energy and stamina I had. I can't begin to imagine what it would have been like waiting for the results of the AIDS test and wondering if I were carrying a child who might have AIDS. Or trying to find a place to live not only for myself but also for a child. Or, knowing that my job performance had plummeted, wondering what would become of me and a child if I were to be let go. Or telling my parents before I was ready not only that I'd been raped but also that I was going to have a child. Or explaining to my students how I came to be pregnant. I can't imagine what it would have been like to be dealing with the health insurance agency about both the emergency room fee for the rape and coverage for prenatal care. It took more than a year—and the help of a lawyer—just to get them to stop sending me bills for my unapproved emergency room visit.
The night of the rape, after all the evidence had been collected, the hospital staff gave me pain medication and offered me "the morning after" pill. I took it. I still remember the overwhelming sense of relief that washed over me the first time I got my period after the attack. On top of everything else, at least I didn't have to worry about being pregnant.
I am so very grateful that in that horrific situation, I was given a choice about emergency contraception. It may have saved my life. There were times after the rape when I thought about suicide. My guess is that to have been faced with an unwanted, unwelcome pregnancy would have pushed me over the edge.
I offer my story in the hope that it may make a difference for other women who are victims of sexual assault. My fervent prayer is that they, too, will have the opportunity to make a choice about whether or not to continue a pregnancy that they did not have any say in creating.
Elizabeth Cracco, Ph.D., Coordinator of the Violence Against Women Prevention Program University of Connecticut Women's Center, testified: ". . . I would like to provide you with critical information regarding the effects of trauma during the time immediately following assault. Rape Trauma Syndrome, first conceptualized by Burgess and Holmstrom (1974) identifies this period immediately following the assault and lasting for several days post-assault as the acute or impact phase. Symptoms characteristic of this phase are organized into two categories. The first category known as positive (in lay terms symptoms that we can "see") or expressed style can be marked by acute anxiety, hyperarousal, fear, restlessness, shaking, and crying. A second, and sometimes thought to be more common presentation, is categorized as negative or controlled style, which can include numbness, apathy, dissociation, and avoidance. Victims may also alternate between these states of hyperarousal and numbness. The important point is that in both cases, the outward presentation stems from internal experience of coping mechanisms being overwhelmed.
"Clinical trauma assessment of victims seeking emergency room care within 72 hours of their assault validates and expands on Rape Trauma Syndrom, by identifying three broad categories of trauma – expressed emotional trauma, controlled emotional trauma and cognitive trauma (Ruch, Gartrell, Ramelli & Coyne, 1991). In my experience it is common for victims to express confusion, fear, a sense of shock or unreality and most of all helplessness and powerlessness. Indeed, recent advances in neuroimaging technology have allowed us to understand that trauma influences the basic structure and operation of the brain and therefore the resulting patterns of cognitive, behavioral and emotional processing. By way of analogy, the brains alarm system behaves like an alarm system you may have at your home. After a violent electrical storm it can be short-circuited, the system becomes overwhelmed, such that it may react to the slightest provocation, or it may be totally unable to discriminate danger appropriately.
"During this period of extreme dysregulation, how a victim copes with sexual assault can be contingent upon her interaction with service providers immediately following the trauma. Everyone the victim comes in contact with, including friends, family, police, advocates and health care providers are all crisis responders, and can and should work toward meeting the basic needs of the victim during this acute phase of trauma.
"Your own reactions to trauma experiences may provide a useful reference point into the nature of these basic needs. During our shared trauma of witnessing the attacks on 9/11 many of us gravitated to the people and places that felt safest to us, physically and emotionally. Some of us wanted to talk about what we were seeing, and we all wanted more information about what was happening and what would happen. In my experience and according to the research literature, those reactions reflect the same immediate basic needs felt by survivors of sexual trauma, which are: 1)the need to feel safe, 2) the need to express emotion, and 3) the need for information about the decisions and processes one faces (Woods, 2000).
"Survivors have experienced their own source of terror and are often terrified. In that state, we ask them to make complex decisions about reporting, to sit for long hours in chaotic and public waiting rooms, to undergo a long and invasive physical examination. Research shows the exam alone can last up to 8 hours, and on average is 3 hours, not including time in the waiting room, or the time spent deciding to seek treatment (Ciancone, Wilson, Collette, & Gersen, 2000) . In my direct experience, survivors are scared and anxious about many things, ranging from where they will go next, and where they will be safe, to whether they will have to deal with pregnancy. Failing to provide survivors with basic information regarding emergency contraception, forcing them to go elsewhere after undergoing an exam to receive "treatment, or transferring a survivor from one hospital to another reflects a standard of care that is negligent. This practice ignores those basic needs for information and safety, and fails to consider the disorganizing impact of the trauma that the victim is experiencing. Knowledge of trauma and the basic needs of survivors identified in the research should compel us to simplify victims' experience of care insofar as possible. Evidence shows that the existence of regulations and written protocols calling for emergency contraception translates to increased provision of this care for survivors (Martin, Young, Billings, & Bross, 2007). I urge you to support this important proposal that would require all hospitals across the state to meet the basic needs of survivors by providing them with the full range of information and treatment, including provision of emergency contraceptiom".
Carissa Simpson, Coordinator of Advocacy Services for the Sexual Assault Crisis Services at the Women & Families Center in Meriden, Middletown, New Haven testified: "I want to tell you about two recent experiences I have had assisting rape victims and their struggle to obtain emergency contraception.
"The first case was that of a young woman who was drugged and raped by an acquaintance. She was brought to the emergency room within 48 hours of the assault. She was upset and confused, and a little woozy from the effects of the drugs the rapist had given her. I supported the victim through the rape kit and evidence collection exam, explaining the process to her as she was still groggy and sleepy. The victim was concerned about the possibility of a pregnancy, so I advocated for the doctor to give her Emergency Contraception. The doctor stated that he had been ordered not to give EC under any circumstances. I pressed him on this because I knew the victim, in her present state, would be unable to go elsewhere to obtain the medication and she really only had a small window of time in which EC would still be effective for her. The victim also begged the doctor to give her at least a prescription for EC. After much pleading and tears on the part of the victim, the doctor gave her a prescription. By the time we were finished, her parents and the friend who brought her to the hospital were there to take her home and ensure she got the prescription filled. She may have gotten it just in time but was exhausted from the fight she
"More recently, an advocate that I supervise was called to the hospital to assist a victim with a disability who had been repeatedly raped by a neighbor who used a weapon and threats of violence during his assaults. These rapes had been ongoing for several months and it was only after speaking with advocates on our hotline, the victim felt safe and empowered to seek help within 72 hours of the final attack. The victim was extremely frightened but also exhausted and stressed from the violence she had endured.
"The exam took several hours and was a challenge due to the victim's disabilities. She was amazingly patient and got through the exam. The victim asked about EC but was not given any information about it. She was told that she would have to have a test done to determine if she was pregnant or ovulating. The victim was willing to comply, however she was unable to give a urine sample. She was asked to provide a blood sample which she felt was invasive and made her very emotional. She was told that the results of the blood test would be available in 24 hours. At some point during the visit, the victim was given antibiotics to treat any potential STDs, but in the confusion of the process, she assumed she had been given emergency contraception. It wasn't until two weeks later, when the victim read her medical records, that she found out she had never gotten EC and the hospital never called with the results of her blood test. The victim was in shock and was upset and devastated that she might have to endure a pregnancy by the man who so brutally attacked her.
"Unfortunately, the clock had run out on this victim. After suffering through months of vicious rapes and finally having the courage to come forward, this victim was denied a vital medicine that would have eased her mind and allowed her to begin her healing journey. I have since been counseling this woman who still hasn't gotten over the disappointment and betrayal she feels by the way she was treated at the hospital that day.
"I urge you to vote in support of Senate Bill 1343 to assure the women of Connecticut know that they will receive compassionate care at all of Connecticut's hospitals if they are victims of sexual assault".
Colin Moore, Governmental Relations Manager, Planned Parenthood League of Massachusetts testified: "I urge the committee to approve this important legislation without any modifications that would delay the ability of sexual assault survivors to avoid unintended pregnancy.
"In 2005, Massachusetts enacted Chapter 91 of the Session Laws that year that also mandated that emergency rooms provide information about emergency contraception (EC) to all sexual assault survivors and EC itself upon request. Planned Parenthood, along with other advocacy groups, worked hard to defeat attempts to weaken the bill, which included, among other things, proposed refusal clauses and referrals to other hospitals.
"We are proud that the law as passed contained none of these delays. Provision of EC to sexual assault survivors proved to be a clear example of "common ground" which legislators from across the choice spectrum could agree on. The bill passed overwhelmingly and easily withstood our former governor's veto.
"After passage of the law, our former administration initially tried to claim that the law did not apply to religiously-affiliated hospitals. They quickly reversed themselves after hearing widespread criticism from the public. A phone survey of Massachusetts voters conducted last year by RKM Research found that 67% of Massachusetts voters oppose exempting Catholic hospitals from our emergency contraception law, including 62% of Catholic voters.
"When used in a timely manner after a sexual assault, emergency contraception is very effective at reducing the risk of unintended pregnancy. Timely access is imperative, as emergency contraception is most effective when taken within the first 24 hours. EC is safe and effective. It is not RU-486 (the abortion pill). If a woman takes EC during pregnancy, it will not harm the developing fetus or cause an abortion.
"Hospitals that accept public funding have an obligation to provide the full range of appropriate care to their patients. These facilities have a responsibility to provide the standard of medical care to women who have been raped. The standards for compassionate treatment should be uniform across the state. Rape survivors should be given every opportunity to prevent an unintended pregnancy in a timely fashion, regardless of what hospital they arrive at for care.
"Hospitals are not religious institutions. They are largely funded through public tax dollars, they hire staff with different religious backgrounds, and they serve patients from a wide variety of religious faiths. Rape survivors do not get to choose what emergency room they are brought to. No rape survivor should have her health jeopardized by the delay that a refusal clause could create. She should not be subjected to a second trauma by being refused treatment that is part of the standard of care that the medical community has endorsed for victims of these terrible crimes.
"Emergency contraception provides a safe and effective method of preventing unintended pregnancy. SB 1343 will improve access to EC for rape survivors throughout Connecticut. I urge you to give the bill a favorable report".
Amy Miller, Program & Public Policy Director at the Connecticut Women's Education and Legal Fund (CWEALF), testified: "I am writing to urge you to support S.B. 1343 An Act Concerning Compassionate Care for Victims of Sexual Assault. This bill is important to securing the dignity and safety of women at a traumatic time.
". . . we have worked on access for women to make informed and appropriate choices about their lives. We support SB 1343 for this reason. Requiring hospitals to provide emergency contraception to rape survivors would rectify the current gap in emergency care and ensure that women of all income levels would have access to every available means to protect their health and well-being. Sexual assault victims have already suffered and should not have to face the further trauma of unintended pregnancy. Routine counseling about and the provision of emergency contraception would help rape victims avoid unintended pregnancy, prevent abortions, and safeguard the victims' mental health and protect their reproductive health and rights.
"Many hospitals refuse to inform sexual assault survivors about the availability of emergency contraception and even few provide emergency contraception on the spot. During the first six months of 2006, 40% of rape victims were not offered or did not receive the full dose of emergency contraception at the hospital from where they went for treatment.
"Women who have been raped who do not obtain emergency contraception in an emergency room must track it down on their own. Low-income women and women without health care in particular have fewer options when it comes to seeking medical assistance. They may not be able to access additional resources once the initial hospital examination is performed. In addition to the emotional and financial burden this imposes, a rape victim would face increased risk of pregnancy because of the delay inherent in having to take further steps to track down emergency contraception.
"Standards of emergency care established by the American Medical Association, among other groups, require that rape survivors be offered emergency contraception. A 2006 poll conducted by Quinnipiac University found that, by a 78-17 percent margin, including 74 percent of Catholics, voters support a law requiring Connecticut hospitals, including Catholic hospitals, to provide emergency contraception to sexual assault victims. Rape survivors should be able to make treatment decisions based on accurate and complete medical information and their own ethical or religious beliefs. Emergency care facilities treat people of many faiths, and should not be allowed to impose one set of religious beliefs on the people of diverse backgrounds who seek care.
"We need to support women who have been raped. We can reduce the stigma and trauma associated with rape by treating women with dignity and respect from the moment they begin their treatment. A key component of that respect is respecting a woman's right to make the medical decisions that are in her best interest. Please support SB 1343 and show that Connecticut is committed to the physical and social health of our women."
Matthew L. Saidel, M.D. Medical Director, Womens Health Connecticut and Physicians for Women's Health & Practicing OB-GYN in Greater Hartford, testified: "First of all, I completely respect the need for diverse health care institutions in our community. Patients need to be able to choose the institution where they feel the most comfortable, and that share their belief system. Rape victims do not have that choice.
"Most rapes go unreported. Why? Because patients feel violated, they feel ashamed, and mostly because they have completely lost their trust in their fellow humans. I have personally cared for rape victims in emergency rooms for more than thirty years. There are many unspeakable pictures that stay with me during sleepless nights, but the one that I remember most is the victims' eyes. Their eyes are not frightened or angry; they are distant, vacant, as if they have retreated into some small dark place within themselves to hide from the unspeakable horror of what has just occurred. The first thing we say to a victim of a sexual assault is not "Who did this?", or" where did it happen?" The first thing we say is "You are safe". These women have made a superhuman effort to crawl into the hands of the healthcare system, and they collapse, in shock and exhaustion. We need to begin the difficult task of rebuilding their trust in someone. Although we cannot prevent the psychological scarring, we can promise to keep them safe from further physical harm, and the physical consequences of the assault: infection, injury and pregnancy. In the ER, they don't hear much of what we say. That is why we have crisis counselors to stay in contact so that several days later, when they are ready to begin to emerge a little bit from that deep, dark hiding place, that we can maintain contact and reach out a helping hand. They cannot understand a litany of instructions about where to go, what medicine to buy, how much to take. We need to care for them then and there, and not ask them to expend any more effort than the unbelievable struggle it took to come to a friend or a policeman or a hospital.
"A brief biology lesson: We all know that most couples happily trying to have a baby do not get pregnant the first month. When the sperm and egg unite, the fertilized egg rolls down the tube and often passes right through the uterus because it does not find a comfortable place to grow. That is why perfectly healthy couples often take months to conceive. On the rare occasion that it does not prevent the egg from being released, emergency contraception simply makes it much more likely that it will not find a place to land.
". . . I trust that the legislature will pass this bill, and I believe that all of our hospitals can find a pragmatic solution to making this option available to rape victims somewhere within the framework of their institution. We must above all care for our patients. Please support SB 1343. The health care needs of our patients must come first".
Ellen Small, a graduate student at the UConn School of Social Work testified: "A woman who has been the victim of rape will forever carry with her the traumatic experience of being violated, abused, and brutalized. I cannot even begin to imagine the lifelong devastation endured by victims of such a horrific crime.
"This bill recognizes that victims of sexual assault respond to and cope with their trauma differently. This bill gives victims a choice. Although it would not erase the traumatic memories of rape, this bill would give victims of sexual assault one area of control in the midst of chaotic, overwhelming, and uncontrollable circumstances.
"I testify today in support of this bill because if I were the victim of a sexual assault, I could not imagine my choice in how to cope with such a horrific situation being limited not by science or technology, but by the policy of the hospital at which I sought care. I could not imagine being denied the choice to take an emergency contraceptive that could prevent me from becoming pregnant as a result of the assault. I could not imagine being denied that choice only to later be forced to choose between giving birth to a child conceived through rape or terminating the pregnancy—a choice that could actually leave me further traumatized regardless of which decision I made.
"Each year, sexual assaults and forcible rapes account for an estimated over 20,000 pregnancies, thousands of which are later terminated. Offering survivors of rape . . . information and access to care and treatment needed following their assault, can lead to a patient's decision to utilize emergency contraceptives to prevent a pregnancy from rape.
"Plan B is similar to other oral contraceptives. It does not terminate a pregnancy, but rather prevents one by preventing ovulation. The distribution of this contraceptive to victims of sexual assault can help prevent abortions, protecting victims from having to make additional agonizing and traumatizing decisions. Offering emergency contraceptives to victims of sexual assault gives patients the ability to make treatment decisions based on an understanding of medical treatment options and their own ethical beliefs.
Frances Park, RN, testified: "I am a CT registered nurse and survivor of sexual abuse by clergy. I am urging your support of SB 1343, An Act Concerning Compassionate Care for Victims of Sexual Assault. There is every reason to require emergency rooms to offer emergency contraception to sexual assault victims. "Plan B" (Levonorgestrel) is a safe medication that is 95% effective in preventing pregnancy within the first 24 hours after sexual assault. Its use in medical treatment after rape is supported by: the American Medical Association, the American College of Emergency Room Physicians, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics (yes, doctors for children), and the American Public Health Association. In other words, emergency contraception is part of generally accepted medical care for victims of sexual assault.
"Plan B contains the same ingredients as regular oral birth control. It does not induce abortion. It will not terminate an established pregnancy. It is only useful for prevention of pregnancy. Plan B, is sold over the counter and on the web. While emergency contraception can be taken up to 72 hours after sexual assault, its effectiveness drops to 60% within 48 to 72 hours after rape. The best chance for success in preventing unwanted pregnancy from sexual assault is immediate care.
"Connecticut women who need emergency contraception after sexual assault are mothers, sisters, daughters, maybe even grandmothers. Anyone can becomes a victim of sexual assault. Women presenting to emergency rooms have already endured the trauma and pain of sexual assault and have summoned their courage to seek medical treatment (yes - it is an act of courage to seek emergency room care after sexual assault.) Immediate care should be complete before leaving the emergency room. By statutory regulation, only certain licensed health care providers are permitted to prescribe and dispense medication. No such health care provider should be allowed to deny this simple, effective measure based on their personal beliefs. Public funds support emergency rooms and it should be public policy that simple, effective pregnancy prevention be offered at the time the woman seeks initial treatment for sexual assault.
"Our sexuality is at the core of each of us. It is something basic to our definition of self. Sexual assault damages that inner core. Whether or not people heal from sexual assault depends, in part, on how the community responds to it. Like being a little bit pregnant, there is no middle ground. As community leaders, you are being called upon to make the choice that, one way or the other, will have life long repercussions for Connecticut citizens victimized by sexual assault. I am asking you to make the choice to help minimize a rape victim's experience of trauma and allow her the immediate medical care that is generally accepted by medical experts. I am asking you to make the choice that will prevent some health care practitioners, working in publicly funded emergency centers, from imposing their personal beliefs on rape victims who seek their help. Such a demand is oppressive, discriminatory, and has no place in the Connecticut health care system.
"Your vote to support SB 1343 is a vote for the health and well being of Connecticut women and their families. It is a vote to curtail the punishing aftermath of sexual assault. Emergency contraception has nothing to do with abortion, only pregnancy prevention. It is simple, effective, and safe. Please vote "yes" for Compassionate Care for Victims of Sexual Assault".
Heidi Voight, Miss Connecticut 2006, testified: "As Miss Connecticut, my official service platform is entitled "Educate, Empower, Eradicate: Stop the Violence," and seeks to address the issue of sexual assault through primary prevention while advocating for victims rights. This issue is of paramount importance to me because I am a survivor of both childhood sexual abuse and sexual assault as a teen. I have spent the past five years and will spend the rest of my life advocating for the rights of rape survivors because I understand firsthand what it is like to have my power and control taken away from me in an act of violence. I am empathetic to the plight of rape survivors because I too have suffered at the hands of those who lacked human decency and respect for my very humanity; I know this reality because I have lived it. I am here today to give voice to those who suffer in silence and shame so that they might be treated with the respect and compassion they are owed by those whose duty is to care for them.
"In following this issue, I have been dismayed at the way in which the heart of the matter seems to have been lost in a whirlwind of misinformation. I have been disheartened, even insulted to witness a campaign of factually false information employed to distract the public from the truth. I see this becoming a debate of irreconcilable ideologies and abstractions, and I fear that we are losing sight of what this issue is truly about: a woman, or a girl, sitting quietly in a hospital bed somewhere, shaking, terrified, numb, beaten, bloody, alone… and wondering. And I can assure you with authority that she is not wondering about frivolous abstractions. She is more occupied with the immediate, tangible reality that has been slammed upon her world, and the ticking clock running out. By coming to a hospital she has placed her faith in the hands of an institution -whose sole purpose for existence is to provide immediate care for the wounded and sick- to do its job. As a publicly funded institution, every single hospital has an obligation, a duty, to comply with medical standards by putting the beliefs and needs of its patients first, without exception or excuse.
"It is clear to me that those who are shouting loudest against this bill are not people whose lives have been permanently altered by rape. I believe that because nobody in their right mind who fully understood the scope of the rape experience would be so heartless as to dehumanize victims in the way that I've been witnessing in this debate. By shifting focus away from the realities of the rape experience to intangible ideological debates, the real issue is kept a comfortable, safe distance away. Meanwhile, rape victims are waiting for us to get to the point and restore their rights.
"In a single act of sexual violence I had my innocence robbed, my body wounded, my soul devastated, my life permanently altered- my power and control over my physical, mental and spiritual self taken from me. My basic rights as a human being were taken away. I could not talk. I could not walk. All I could do was convulse and cry and be terrified. Unless you have experienced it yourself, you cannot understand the feeling of utter helplessness a rape victim feels in the aftermath, viscerally and spiritually. But what you can do is give her back her basic human dignity when she looks to you for help by letting her decide what care she wants to receive. And if the thought of restoration of basic human rights to rape victims makes you uncomfortable or outraged, my recommendation is to redirect that outrage towards a much more worthy recipient: those who would degrade and assault women and teen girls. And if you really want to understand what it is to be "forced" to do something you're not comfortable doing, I can tell you who to ask: any rape victim. You can start with me.
"I stand here today in support of this bill asking you to not let the voices of survivors like me get lost in the din of abstractions and assumptions. So-called "solutions" that are rooted in assumptions are not solutions so much as they are an easy way for the opposition to absolve their guilt and pass the burden back onto the shoulders of the victims. Don't assume that a woman has her own car waiting out back to get to the next hospital an hour away. Don't assume she has money for a taxi, or can just put her torn clothes back on to hop on the next city bus. Don't assume that a woman who has been beaten within an inch of her life had a say in where the ambulance took her. Don't assume that a woman has insurance to pay for emergency contraception at a pharmacy, that a pharmacy has stocked the drug; that a pharmacy is even open when she is racing against the clock, or that she, after being violated in the most intimate way, can stand in a paper hospital gown and announce her need next to someone who is there to buy cough syrup or allergy medicine. Do not add insult to considerable injury by denying her of compassionate care.
"Plan B is not abortion. Plan B does not terminate a pregnancy. To intentionally ignore this fact and opt instead to selectively present misinformation to the public is unethical, irresponsible, hypocritical, and morally reprehensible. This is not an attack on religion. I have not devoted my life to fighting sexual assault because of religious intolerance. Rather, as a woman of faith, I do it to help those with broken wings learn how to fly again, and to do my part to help better humanity. To accuse this bill's supporters of harboring an anti-Catholic agenda is a heartless, ignorant slap in the face to survivors like me. The only matter of faith that should concern any of us is simple: the faith that a victim has placed in the doctors and nurses to protect her, care for her and respect her wishes- it's the same faith that citizens all over our great state have placed in our very capable legislators to protect them. On behalf of survivors of sexual assault in the state of Connecticut, I implore you to do the right thing by supporting SB1343".
Jillian Spies, Steering Committee Member, The Young Women's Leadership Program, A Project of the CT General Assembly's Permanent Commission on the Status of Women, testified: "Sexual assault is a regular occurrence in our society that overwhelming impacts the lives of many of Connecticut's young women. As a young woman, I am ever mindful of sexual violence and the threat that such a violation can have on my body and mind. But for my generation and the generations to come, the advent of Emergency contraception as a medical standard of care has given us one less thing to fear from assault-becoming pregnant at the hands of a rapist.
"Formerly, I worked as a Sexual Assault Crisis Advocate and currently I am a student with UCONN's Institute for Violence Prevention & Reduction. This work has exposed me to a variety of issues associated with sexual violence. As an advocate, I accompanied victims during hospital exams and spoke with countless survivors via a 24-hour hotline and now as a student, I would like to plan for ways to reduce and prevent sexual violence. Making emergency contraception accessible and available to women at the hospital is an easy fix that the state should institute without debate.
"Opponents of SB 1343 argue that rape victims can go elsewhere for Emergency Contraception or that crisis advocates or EMTs should be responsible for informing victims about certain hospitals that will not offer the drug. This line of reasoning doesn't mesh with the realities of rape, because sexual assault happens within a context, and no two assaults are ever the same. What happens to a woman following a rape depends on a variety of things, many of which the state cannot plan for. But, if by chance she enters a Connecticut hospital, then the state should be prepared to have her informed about Emergency Contraception.
"For a large majority of women, being raped means a possibility of getting pregnant. We, as a state, cannot reach out to all victims, but those who enter a hospital should be offered and then receive emergency contraception on site. Emergency Contraception is an accepted medical standard of care and has been FDA approved as a back-up for preventing pregnancy-why wouldn't a hospital offer it?
"As a Connecticut lawmaker, you have worked to improve laws that track sexual offenders once they have been released into the community and last year certain lewd sexual acts became a punishable crime. I applaud your efforts and ask that you continue your commitment to protecting women against sexual violence.
"When a woman is raped in Connecticut, she should expect that her ER will do everything medically possible to prevent her from experiencing further trauma. Please support SB 1343, and give sexual assault victims the compassionate care that they deserve".
Judy Singer, representing the National Council of Jewish Women, testified: "This legislature cannot predict the circumstances under which a rape victim arrives at a hospital emergency room. The legislature cannot predict what she will know about emergency contraception, her means for purchasing it, her ability to access it in a timely manner, the availability of transportation, the time of day or night, her physical condition, whether she will be admitted to the hospital, nor her mental state. We do not know what her religion may be.
"All rape victims must be treated equally throughout the state and the standard of care must include: 1.) providing medically accurate information about emergency contraception and how taking it might prevent an unwanted pregnancy, 2.) offering the victim the option of obtaining the full dose of that medicine, 3.) providing the full dose of that medication if the rape victim requests it.
"A rape victim should not have the additional worry that she may become pregnant from the assault she has suffered. She should not have to discover later that the doctors, nurses and other medical personnel at the emergency room she went to after the rape, willfully withheld information and did not tell her that there is a way she might prevent becoming pregnant from the rape.
"Patients must be able to make treatment decisions based on accurate medical information and their own ethical or religious sensibilities. The religious or moral beliefs of a caregiver cannot be allowed to obstruct a patient's access to care. As long as all hospital emergency rooms treat all members of society and accept public money, they cannot impose their religious beliefs on victims of rape. Because all hospitals in our neighboring states of Massachusetts and New York, including Catholic Hospitals, are providing emergency contraceptives to rape victims without objection, we can see that a very narrow and medically unsound interpretation has created this problem at some of our hospitals.
"A large percentage of Connecticut residents believe that rape victims should be offered emergency contraceptives in every emergency room throughout the state. It is unconscionable for a health care provider to be excused from providing what Connecticut residents consider to be the most basic care in these circumstances.
". . . Many hospitals around the state are falling short if rape crisis advocates are reporting that rape victims have not been informed of emergency contraceptives, offered them in the hospital, nor received a full dose. If the hospitals will not accept the responsibility of providing this standard of care on their own accord, then our state legislature must pass a law that compels them to do so".
Laura Cordes, Director of Policy and Advocacy Connecticut Sexual Assault Crisis Services, Inc., testified: "I am here today in strong support Senate Bill 1343: AN ACT CONCERNING COMPASSIONATE CARE FOR VICTIMS OF SEXUAL ASSAULT. This bill is about addressing the health care needs of rape victims and providing them with the emergency treatment they need following an assault.
"Emergency Contraception (EC) provides psychological relief for victims who rightfully fear becoming pregnant as a result of rape. We don't have specific numbers in Connecticut, but nationally an estimated 25,000 women annually become impregnated by a rapist. With accessibility to EC, rape victims are spared the agony of waiting to find out if they must bear a rapist's child. Emergency Contraception is part of the standardized, appropriate care that is now being provided to rape victims at the majority of Connecticut hospitals, and supported by leading health organizations.
"It is a time sensitive medication. When taken within the first 24 hours after a rape, EC is 95% effective. The sooner it is given, the more effective it is. Victims should not be referred elsewhere or given a prescription. EC would have no effect on an existing pregnancy. EC prevents a pregnancy; it does not cause an abortion.
"Inconsistencies in treatment for rape victims vary across the state at both secular and Catholic affiliated hospitals. Certified sexual assault crisis counselors who respond to the hospital when called to support rape victims at all hours of the day and night, report that while the majority of victims receive the full dose of EC on site, others receive the first dose plus a prescription for the second dose, which must be taken twelve hours after the first, while still others receive a prescription or nothing at all.
"Last year in Connecticut, the state reimbursed hospitals for over 1100 sexual assault exams and evidence collection kits. Rape crisis counselors accompanied nearly 400 adolescent and adult females for emergency medical treatment following a sexual assault. Some had been beaten. Some had been robbed. Some suffered from physical or psychological trauma. Some, whether due to shock, fear, or physical coercion, were unable to choose the timing or location of their treatment. Some went wherever the police took them, while others chose the hospital where they hoped no one would know them.
"Over the course of the last year, rape crisis counselors reported that 28% of the victims at risk of pregnancy from the assault were not given the full dose of emergency contraception on site. Inconsistencies were found at 18 hospitals, including 15 secular ones. We know, however, that this is not a full picture, because we are not always called to support every victim, and we are not called to every hospital.
"Rape crisis counselors have relayed stories of how they have driven around town in search of an open pharmacy, or in search of one that stocks emergency contraception; how they feared that the exhausted and traumatized woman they sat with for hours at the hospital would not likely make it to the pharmacy the next day; or how they have had to talk doctors into giving the full dose on site so the victim could go straight home.
"These inconsistencies happen for a number of reasons. Providers may be unsure of the policy at the hospital where they work; others still confuse emergency contraception with the abortion pill, while others are reluctant to give medication that will be taken off site. CONNSACS is working with the hospitals in the state to develop protocols for treating sexual assault victims, and ensuring they are getting the appropriate standard of care. However, last year, the Catholic Conference asked their affiliated hospitals to adopt the first known policy in our state that would deny emergency contraception to rape victims when they need it most: when they may be ovulating. Some of the doctors and nurses at these hospitals now have their hands tied. They are afraid to speak out about being forced to subject women to an unnecessary and inappropriate medical test that is only used to deny care and is of questionable validity.
"Rape crisis counselors work hard to make sure victims know how to access emergency contraception and that doctors and hospitals are trained about the effectiveness of emergency contraception. But we are not always called, rape victims do not always want to engage in follow-up care, and we have found that training a new set of medical providers is a short-term solution. Rape crisis counselors are part of the solution, but we are not the solution.
"There is an urgent need for a clear and consistent policy that would apply equally to all state licensed, publicly funded hospitals to ensure that rape victims who come forward to the hospital are offered the full dose of emergency contraception. Victims should not be denied urgent health care based on where they live, the hospital to which they are taken, or the beliefs of the hospital or individual physician or nurse. SB 1343 would address the inconsistencies in treatment to rape victims and ensure that no matter to which hospital a rape victim is taken, she is offered medication to prevent a pregnancy.
"We have an obligation to care for crime victims who bravely come forward and aid the state in the prosecution of the offender by undergoing the sexual assault exam and evidence collection process. This exam is extremely invasive and time consuming, referred to by some survivors as the second rape. We have an obligation to provide appropriate care and treatment, to prevent further injury from the crime, to prevent a possible pregnancy from the rapist, so a woman who survives rape will not have to agonize over the mere thought or bear the reality of choosing between bearing the child of the rapist or having an abortion.
"When hospitals deny rape victims Emergency Contraception they are make an erroneous assumption that all victims of rape can easily access EC through a referral. That there are enough pharmacies open at 2am? That the one pharmacy that is open carries emergency contraception? That all rape victims conveniently have their wallets with them, or that rapists are kind enough to leave them with an insurance card and money for a prescription?
"These are the realities that rape victims face, and why emergency contraception, a time sensitive medication, must be offered and given onsite.
"There is no reason to exempt Catholic affiliated or any other hospital from the obligation to offer emergency contraception in emergency rooms to all victims of rape. All hospitals in Connecticut are licensed to serve the general public and employ people from many faiths (including emergency room personnel who have no problem dispensing EC and, in fact, often see it as part of their medical responsibility to their patients). All hospitals, including Catholic hospitals, rely heavily on public funding for their basic operating expenses. In addition, the State reimburses all hospitals for costs associated with the exam and evidence collection for rape victims (the rape kit), including emergency contraception.
"Opponents of SB 1343 may say this is a religious issue. This is an issue about rape victims and the medical treatment they deserve immediately following an assault. Catholic hospitals in other states, including Massachusetts, New York and New Jersey, provide emergency contraception – why should Connecticut hospitals be any less compassionate in their care for rape victims?
"Is it good enough for our sisters, our mothers, our aunts or our daughters to be simply given a card or referred to other medical facilities during the trauma of having been violated by a rapist in the most personal and horrific way? Absolutely not. Rape victims can't wait…and we urge our legislators not to wait either".
Lena testified: "I am making this statement from my experience as a victim. I am one of such victims who were given the choice of taking the full dose of Emergency Contraception at the emergency room after I was gang raped. I am very grateful for the hospital to have given me that choice.
"September 26, 2003, my life was forcibly changed. I was carjacked, kidnapped, and robbed, by four masked gun men. Then, I was gang raped and nearly killed. Luckily I survived and am sitting here and testifying right now about this Emergency Contraception issue. After I was left for dead, I was carried into the hospital. During the rape and initial physical examinations, I was informed about the possibility of pregnancy and was provided the option of taking Emergency Contraception. I knew I wanted to take it as soon as it was mentioned. I did not want to take a chance to have the agony of carrying a child created by my rapists. Getting pregnant with my unknown rapists who even had tried to kill me, would be the last thing I wanted to happen. Furthermore, even if my rapists were arrested, the idea of not knowing which ones had got me pregnant made me sick to my stomach. I told a nurse that I wanted to take the full dose of Emergency Contraception. When I was in the emergency room, I was so overwhelmed by the attack and the pain of physical injuries and so focused on giving accurate statements to the police and doctors that I did not have any energy left for me to think about the possibility of getting pregnant, even though I had known the existence of Emergency Contraception. If I was not provided information of Emergency Contraception that night, it is scary to think what might have happened. Again, I am very grateful that the hospital provided me the choice of taking the Emergency Contraception.
"I cannot even imagine as a victim to be sent from the healthcare facilities to the pharmacies to get Emergency Contraception. Victims may be traumatized and/or suffer from the physical injuries. Being examined at the healthcare facilities may be traumatizing and humiliating experiences for victims. By sending such victims to the pharmacies to get Emergency Contraception will just prolong such burden and give further agony to them. It is just another cruel thing to do for such victims. For this reason, there may be some victims who wanted to take the full dose of Emergency Contraception initially, and may not end up taking the Emergency Contraception by not going to the pharmacies. Since there is a time limit for this Emergency Contraception to be useful, it makes sense that the healthcare facilities that took care of victims provide the information and the option of the pills to them.
"Providing Emergency Contraception to the victims of sexual assault should be discussed and thought of separately from the abortion issue. Being raped is not the victims' choice and because of this simple reason, being pregnant result of the attack is not their choice, either. It is humane and important for all healthcare facilities to provide the option of taking the full dose of Emergency Contraception to sexual assault victims. Whether or not victims take Emergency Contraception should be completely up to them. There may be victims that choose not to take Emergency Contraception and it is, of course, their choice. The fact that victims are given that choice is important.
"There was nobody to help victims when they were attacked. They went through and survived the ordeal by themselves. One of the things healthcare facilities can do for such victims is to give semblance of comfort that they deserve after the attack in informing them the possibilities of what may come of the rape and giving choices what they can do about such possibilities. It may not be easy things for victims to listen. It is, however, better than not knowing such possibilities and not having options. Again, being raped is not the victims' choice and neither being pregnant results of the rape. Nobody in this world has the right to give victims the responsibility and burden of carrying and raising children of rapists without their consent. It should be the entirely the victims' choice.
"Please put yourself into the victims' shoes and think about following questions. Would you not want to have the choice of taking the full dose of Emergency Contraception after your body and soul are violated? Is it fair for you as a victim to be limited to access Emergency Contraception because of the healthcare facility's belief? Please keep in your mind that you may even not have the choice where you are carried. How would you feel if you were not given proper information and choice of taking Emergency Contraception, and because of that you have to live with agony of not knowing if you got pregnant with your rapist's child? How would you feel if you are sent to the pharmacy to get the pills after you have gone through the humiliating and scary experiences of rape and rape examinations? Do you really think that you would have any energy left to stop by another place and wait in line to get the pills after such ordeal? The answer should be easy and simple.
"Again, please put yourself into the victims' shoes and think about this issue. This issue is not about the abortion. This is about the victims whose body and soul were both violated. This is about providing choices to victims that they deserve. Being sexually assaulted is not the victims' choice, and nor is being pregnant with the rapist's child".
Maura Keaney of Stamford testified: "As a Catholic, I have received many alerts about this bill and have been deluged by exhortations to come to Hartford today to oppose the bill on grounds of religious freedom. I knew the opposing side would have a very high turnout today, but it is not as easy to testify in public on camera in opposition to Church leaders. A Quinnipiac University poll last year showed that 74% of all Catholics here in Connecticut support this bill mandating a standard of care for emergency medical treatment for rape victims in the immediate aftermath of rape. But most Catholics who disagree with Church leaders' positions on political hot-button issues do so quietly, not wishing to expose themselves in defiance of Church leaders. This is difficult for me, but I speak here today because I know so many of us support this bill but feel we must stay silent.
"More importantly, though, I struggled because it is difficult is to testify in public, on camera, about a personal experience with sexual assault. Those of us who have survived rape or who have sisters, mothers, daughters, wives, friends, and loved ones who have survived rape know how difficult it is, even many years or decades after the fact, to talk about rape and its immediate aftermath at all, much less talk about it to strangers in public on camera for all to see on television and the internet.
"It takes immeasurable courage for a woman to come forward and seek medical treatment in the immediate aftermath of sexual assault. It is courage I myself did not have. I speak now because I could not speak then.
"I speak for women whose last ounce of courage is spent telling her story to an intake nurse, waiting in the harsh fluorescent glare of an emergency room waiting room, telling her story again to more medical professionals, and undergoing an invasive rape exam. I speak for women who, after going through all that, can't possibly face having to find a different hospital and and having to speak about her assault to a whole new set of strangers in order to prevent a pregnancy.
"I speak for women who don't have access to information on the Internet like I do and may not even know that emergency contraception is available to prevent pregnancy in the aftermath of rape and who deserve medically accurate information and access to this medication immediately upon seeking medical treatment.
"I speak for women whose physical pain is compounded in the immediate aftermath of rape by emotional torture, which could be substantially alleviated by being offered the choice to use emergency contraception to prevent a pregnancy.
"There is a misconception out there that Plan B is widely available now that it can be found behind the counter at some pharmacies in the state. I live in one of our largest cities, with more than a dozen pharmacies in a 10-mile radius. A few weeks ago, I got a survey from an advocacy organization asking about availability of Plan B in our community. I called my pharmacy, a national chain that had announced it would make Plan B available. The pharmacist told me they stock the medicine, but when I asked her whether it actually was in stock, she came back after five minutes on hold to tell me they had none. When I asked how soon it could be available, she said it was on back order from the manufacturer. I then called a national discount big-box retailer in Stamford which had a pharmacy. They did have the medication in stock at a cost of $39.99. One could look at that and say that rape victims should have no problem finding the medication themselves, but we'd be looking at that from our comfortable positions of relative wealth, of owning cars, of having access to the Internet, of having the courage to tell another person to get help with transportation, and – most importantly -of not being in profound post-traumatic agony in the immediate aftermath of rape. This is not a time when women should be expected to shop around for medical care. This is a time when any woman courageous enough to speak and seek immediate medical attention should receive just that – IMMEDIATE medical attention in whichever emergency facility she is able to get to.
"And make no mistake about it – simply OFFERING Plan B to a woman in the immediate aftermath of rape, when the pain of the rape itself is compounded the post-traumatic psychological torture of fear of curable and incurable diseases, societal reactions, future prospects for healthy relationships, and fear of pregnancy and all its repercussions. That post-traumatic agony could be substantially alleviated by offering a victim the CHOICE of a medication that could prevent a pregnancy from occurring. Now that this option is available, refusing to offer this treatment to women in the immediate aftermath of rape is a dereliction of care.
"As a Catholic and a progressive, I have a deep respect for the mission of Catholic hospitals and value them in our community. Nearly all hospitals now care for the sick for a for-profit motive. Catholic hospitals care for the sick not for profit but as a Christian ministry, and I respect that because far too often, it seems that my Church, which used to be all about social justice, ministering to the sick, caring for the poor, and remembering the least among us, is now defined more by opposition to gay marriage, contraception, and abortion than it is about the abundant love and mercy of Christ. I want non-profit Catholic hospitals to thrive. At the same time, our state has a responsibility to mandate a standard of care in any medical facilities that are licensed by the state. There are religions that oppose blood transfusions. If such a religious organization were to run a medical facility, I don't think for a minute we would be here whether a preferred provider for state-funded emergency care could be licensed if they refused blood transfusions to critical patients. That is not interfering with the free practice of religion – any believer could refuse a blood transfusion himself. That's simply the state doing its duty to mandate a standard of care in state-licensed facilities for state-funded care.
"Likewise, we're simply talking here about a standard of care for victims of sexual assault, no matter where they seek emergency medical attention. Think about your mother, your sister, your daughter, your wife, your niece, your neighbor, and think about the kind of immense courage it would take for her to seek immediate medical attention if she were sexually assaulted. What standard of care would you expect her to be offered by those strangers she had the courage to speak to? If you would expect for her to be offered the option of emergency contraception, you can speak for those women and for all women in Connecticut by voting in favor of this bill".
Melissa Malagutti, Program Director of Safe Haven of Greater Waterbury, testified: "A few months ago, I met a victim of sexual assault at a Catholic-affiliated hospital. She was in her early 20's and had been sexually assaulted by knifepoint in her apartment. She was severely traumatized and was dealing with questioning from police detectives. She was concerned about pregnancy, but was not given EC at the hospital. This victim called into our office the next day and was confused as to where she needed to go to obtain EC-she hadn't been given that information by the hospital staff. We advised her to go to a local clinic. At this point, time had passed and I was not sure she would be able to obtain EC within the 72 hours from her assault. Unfortunately, I never heard back from her. After all she had been through, I truly hoped she was able to get to the clinic and hoped she would be able to survive the possible consequences if she did not.
"I have been a rape crisis counselor for eight years. . . . . In the area that we serve, they are two hospitals, one Catholic-affiliated and one secular. Victims of sexual assault are consistently given emergency contraception at the secular hospital, however, when we receive calls from our local Catholic-affiliated hospital, we must let victims know they have to obtain EC at another location. We have found that the doctors and nurses do not even mention emergency contraception to victims, let alone discuss their options in obtaining it. It is an issue that is simply not discussed. When I meet these women at the hospital after a traumatic assault, I think to myself "after all these victims have been through, why is the responsibility placed on them?" It is the responsibility of the ER staff to dispense this medication at the time of treatment, not for a traumatized victim to have to ask. This is happening too often to victims we serve. Victims of sexual assault deserve compassionate care at every hospital. I urge you to vote YES for Bill 1343".
Sarah Lindahl OB/GYN, Physician Assistant, testified: "The Alan Guttmacher Institute has credited emergency contraception for preventing as many as 50,000 abortions from 1994-2000. However, only 5% of sexually active women have reported using emergency contraception. The approval of Mifepristone as an agent for medical abortion in 2000 appears to have created confusion about emergency contraception and may contribute to women's reluctance. Surveys have observed that 32% of women believe emergency contraception causes abortions and 61% perceive RU-486 as the "morning-after-pill". The mass media has failed to provide adequate clarification and nearly one half of newspaper articles published between 1992-2002 contained inaccuracies that upheld common misperceptions. OB/GYN providers are also culpable as surveys have noted that only 25% routinely discussed emergency contraception with their patients.
"It is therefore imperative that women seeking evaluation after sexual assault receive proper counseling about emergency contraception as part of their treatment. Furthermore, women who want emergency contraception should have it provided to her as part of her treatment prior to her release from the hospital. Studies have demonstrated that the efficacy of emergency contraception is inversely related to the duration of time after unprotected intercourse and delaying a patient's access to emergency contraception is an act of negligence. In an emergency scenario, as a patient experiencing a heart attack is told 'time is heart muscle' or for a stoke patient 'time is brain matter'; for a victim of sexual assault, time could be conception.
"The healing process from a sexual assault is a lifelong journey, and the start of that course should not be burdened by a search for emergency contraception. It is important that the patient have access to the legal and counseling services that she needs at that time. Although, emergency contraception is available without a prescription for women over the age of 18, access is still an issue. Some pharmacists refuse to dispense emergency contraception based on their own moral grounds; others do not routinely stock the product due to insufficient consumer demand. The cost may also be prohibitive to some women. Requiring all hospitals to provide emergency contraception to survivors of sexual assault will ensure that medical standards are upheld and compassionate care is granted".
Shannon Lane doctoral student at the University of Connecticut School of Social Work, resident of West Hartford, testified: "One in every six American women will be assaulted sexually in their lifetime. According to the US Department of Justice's National Crime Victimization Study, 191,670 individuals were victims of rape, attempted rape, or sexual assault in 2005. To make those numbers a bit more concrete, in the time that I am talking to you today, two women in the United States will be sexually assaulted.
"Eighty percent of rape victims are under the age of 30. That makes young women four times more likely than any other group to be victims of sexual assault. Based on the standard incidences of pregnancy during unprotected sexual intercourse, the best estimate is that over 3,000 women become pregnant every year as a result of rape.
The statistics in this area are impressive, but they're just numbers. The women who are affected are people. The numbers suggest that we all know women who have been victims of sexual assault. . . . I ask you to think . . . of all of the other women who are going into the emergency room in the wake of sexual assault. They are not in a position to advocate for themselves. They are not in a position to confront authority. They need to be given the best possible care and every possible support that we have to give them.
Emergency contraception contains the same hormones present in birth control pills. If taken within 72 hours, it can prevent as many as 90% of pregnancies. Several states, including Massachusetts, New York, and New Jersey, already require all hospitals to administer emergency contraception. Connecticut should do the same.
Providing emergency contraception to women who come to the emergency room is the least we can do for women who have already been through a terrible experience. I applaud the Committee for making the time for this important issue, and I encourage you to continue to work to make this legislation a reality".
Shelly Nolan, Sexual Assault Victim Advocate for the Hartford Sexual Assault Crisis Service, a program of the YWCA New Britain, testified: "I would like to share two specific experiences that highlight the difference that compassionate care can make following an assault.
"In one instance, I accompanied a young woman to a local hospital at 3 a.m. She had sought medical attention with the understanding that the medical professionals would provide her with the best services available. Prior to the start of the evidence collection kit, the nurse explained her options. She was overwhelmed, exhausted, and scared. The option of emergency contraception was never offered or discussed. When she questioned the nurse about Emergency Conception, the nurse casually responded that "yes the pill can cause abortion." She looked to me for further information. I explained to her the facts about emergency conception; that it does not affect an existing pregnancy and that if she does decide to take EC the longer she waits the less effective it will be. The thought of becoming pregnant and carrying the child of her rapist was something she was unwilling to do. Upon discharge, this woman left the hospital with no support of family or friends, no money, and no ride. Had EC not been provided to her by the Emergency Room she would have had no means to obtain it. Had I not been present to advocate for this young woman she would have left the hospital without information, without the means to address an urgent health care need.
"On another occasion, I accompanied a woman to a different local hospital. In this instance, the nurse discussed all the woman's options with her. She explained the protocols regarding STD prophylaxis, pregnancy, and emergency contraception. The client explained that pregnancy was something she had not even thought about. She had been so concerned about other things that it had not even been a thought that she could become pregnant from her rape. Again, this notion was an extremely emotional one for her to process. After several minutes, she responded that taking emergency contraception was not a choice but a necessity. Based on the ability of the nurse to provide this client with appropriate and non-biased information, the women left with emergency contraception.
"The need for all women to receive compassionate care is a necessity. Following an assault, it is the job of medical personnel to provide survivors with accurate medical options, allowing each individual the opportunity to make the choice that is best for them. Absent of these choices, we impose our own personal viewpoints on individuals who seek out help when they need it most. It is unfair of any of us to assume that those individuals, who have just survived an assault, have the information they must have in order to make this choice. It is a further assumption that all people have the resources and the means to obtain EC in ways other than receiving it at the ER that is closest or most convenient for them. When a rape victim wants emergency contraception, she deserves to have it with out delay and without judgment.
"In an ideal world, the need for this discussion would not exist. However, in our society we must deal with the horrors of sexual violence on a daily basis. Within our power, we cannot control individuals who choose to perpetrate such acts of violence against others; however, we can control the type of care that survivors receive when they turn to state licensed, public hospitals for help".
Phil Brewer, MD FACEP, Chair, Connecticut College of Emergency Medicine Government Affairs Committee, testified: ". . . we provide compassionate care to crime victims, helping to start the healing process after their ordeal, making them feel that they are surrounded by people who, above all, are concerned with their best interests.
"Unfortunately, when it comes to the care we provide to sexual assault victims, certain hospitals prevent us from providing patient-centered care. In these hospitals, rules which limit our practice override the needs of sexual assault victims. These rules set strict but unscientific restrictions on dispensing emergency contraception and force the victim to seek treatment elsewhere.
"Let me illustrate what that means: Imagine a woman, someone you know well, a neighbor, a family member, out for her evening jog. She is jumped from behind, a knife is held to her throat, she is abducted and taken to a secluded spot where she is raped and beaten unconscious. Found lying bruised and battered, she is taken to the nearest emergency department.
"Once there, she is examined for injuries, X-rays are done, and her injuries are stabilized. Still dazed, she is asked to undergo a special exam to gather evidence of sexual assault. Because the exam must not mis valuable bits of evidence, it is also intrusive and humiliating for her, but she courageously cooperates. After this further trauma, she is presented with treatment options to prevent sexually transmitted disease and pregnancy. If she agrees, she is administered antibiotics, an anti-nausea medication, and two pills to prevent pregnancy. Unless she has the misfortune to be in one of the hospitals mentioned above.
"In one of the Connecticut hospitals that restrict her right to be given emergency contraception, here is what happens: After suffering the trauma and outrage of being beaten and raped, after enduring the humiliation and discomfort of the procedures she has been through in the emergency department, she has an additional test meant to determine if she is ovulating. That this test does not in fact prove whether she is ovulating doesn't matter to the people who make the rules in these institutions, she has to have it anyway. And if the test shows that she might be ovulating, meaning she is at a heightened risk of becoming pregnant by her attacker, what happens? She is told that she is at risk of becoming pregnant, but that that there is a safe, simple treatment that will almost certainly prevent such a pregnancy. Just as a look of relief appears on her face, she is slapped again with the following statement: "But we can't give you those two little pills here because we have our rules. You have to go find them on your own."
"So now, beaten and dazed, with only a hospital gown to wear (unless someone has brought her fresh clothes), instead of going home to shower and try to sleep, she is now forced to go to a pharmacy, if one is open at the time, stand in line in view of every other customer, and wait for her prescription to be filled. At this point, it would not come as a surprise if she just couldn't bear this ultimate insult and she simply went home instead. That would be the wrong thing to do because she could then become pregnant and be faced with the option of having an abortion or having a baby conceived as the result of a brutal attack and a callous disregard for her fundamental rights as a patient. But who could blame her?
"It is time to stop this arbitrary imposition of institutional rules on the rights of rape victims to directly receive every type of medically indicated treatment available. It is time for hospitals who offer emergency treatment to the general public to accept the proposition that in so doing they agree that the needs and rights of their patients are paramount. If it takes a law to force them to allow doctors and nurses to act in the patient's best interests, then we support that law. We support Senate Bill 1343".
Jennifer Blei Stockman, Co-Chair Republican Majority for Choice, testified: "Every six minutes, someone in the United States is raped. This results in approximately 25,000 women facing an unwanted pregnancy each year. It is estimated that 22,000 of these pregnancies could be prevented if victims of rape had timely access to emergency contraception. Plan B emergency contraception is over 95% effective in preventing pregnancy when taken within the first 24 hours following an assault.
"In the first two months of 2006 sexual assault crisis counselors reported that 40% of rape victims were not offered or did not receive the full dose of emergency contraception from the hospital at which they sought treatment. Women facing a sexual assault have already endured high levels of trauma. It is imperative that the State of Connecticut provides these survivors with the hest medical care possible, including accurate information about, and timely access to, emergency contraception.
"Seventy eight percent of Connecticut residents support a law requiring Connecticut hospitals to provide emergency contraception to rape victims. Additionally, Leading Medial Associations, including the American College of Obstetricians and Gynecologists, the American Medical Association, and the American College of Emergency physicians all recognize that offering EC to survivors after sexual assault to be a standard of care.
"Connecticut hospitals must allow decisions to be made by medical professionals and their patients. A 2002 poll showed that 76% of Americans oppose 'allowing [hospitals] to refuse to provide medical services they object to on religious grounds'. A victim of sexual assault has no control over when or where the crime occurs or, in some cases, where they are brought for medical care. A patient in a hospital is not expecting sub-standard care of denial of relevant information due to the political, moral or religious beliefs of medical professionals. Rape victims should be given accurate information from which to evaluate their decision in light of their own values and belief systems, instead of medical professionals imposing personal views upon them. It is imperative that hospitals fully inform patients of all treatment options to restore the victim's control after it has been taken away by sexual assault.
"EC does not cause abortion, but rather prevents a woman from being twice victimized by having to face a decision regarding pregnancy in the days or weeks following a sexual assault. EC contains hormones found in birth control pills; it prevents pregnancy by stopping ovulation or fertilization and will not cause abortion if taken by a woman who is already pregnant. A study conducted by Catholics for Free Choice in August of 2002 found that 28% of all Catholic hospital emergency rooms already offer EC to women who have been raped.
"As a Republican I support common sense solutions to reducing the number of abortions performed each year. Emergency contraception is a safe and effective FDA- approved medication that prevents pregnancy and will ultimately reduce the need for abortion. Republicans and Democrats alike should be able to wholeheartedly back this important bill due to its common sense advocacy for victims of sexual assault.
"Ultimatley Senate Bill 1343 will ensure that victims of rape have the best information and medical care possible in their time of need. I encourage all members of the committee to vote in favor of this vital legislation; it will provide victims with the most complete information about and access to emergency contraception and allow them to make a fully informed decision about their healthcare options".
Cynthia Dugan, counselor/advocate for the Rape Crisis Center of Milford, testified: "It is with great disappointment that I find myself having to prepare this testimony in defense of victims receiving what every individual in this country has a right to expect when they enter a hospital, and that is the right to make treatment decisions based on accurate medical information regardless of the personal opinions of medical providers. . . . A treatment I might add that is FDA approved as safe and effective in preventing pregnancy. The possibility this effort could fail is outrageous and a slap in the face to every victim of this terrible crime, the effects of which can be life altering for her and every member of her family.
"I have heard the opinions of those opposed to this bill. I would say to you in response, this is not a religious issue and to muddy the waters to make it so to promote their own agenda is not acceptable. The dioceses of New York and New Jersey recognize the need and have the compassion to dispense emergency contraception to rape victims. However in Connecticut out Catholic hospital are suggesting that a victim have yet another test to determine if she is ovulating which increases her chance of becoming pregnant by her attacker only to be told that she will not be given EC. As an advocate I am sickened by the impact that would have on a victim. Furthermore to suggest that the availability of EC over the counter alleviates the need for all hospitals to provide this treatment tells me that they do not understand the dynamics of this crime or its effects on the victims. I do, I've been in the emergency room with many of these victims. Let me start by saying it takes a tremendous amount of strength and courage to come forward and seek medical treatment. In doing so they must divulge information about the assault and then endure a necessary but invasive exam and forensic evidence collection kit. To further clarify this picture I need you to know that victims of this crime vary in many ways, and their reaction to this crime is unique as the individual. Many are in a state of high anxiety and can't quite believe this has happened to them. They may have trouble following what is being asked of them and retaining information given in regards to follow-up care. I believe many who oppose this bill picture an adult victim who is in full control of her emotions, or has friends or family with her to help her through this difficult time and aid in the decisions that need to be made. That she will also have the financial means, of insurance coverage to reduce her burden is an inaccurate assumption as well. Unfortunately that is very often not the case. Some have no financial resources at all, many are adolescents who may have been assaulted by a close family member and are terrified to tell anyone for fear of not being believed or supported. Should a 13 year old Jane be forced to carry her father's child because the hospital she turned to for help refused to offer her EC? How does she access it from a pharmacy? Should the 35 year old married mother of three be expected to carry her attacker's child, whether it is a stranger who assaulted her or perhaps her next door neighbor? How does she now tell her husband that although she went for medical help she was not given the option of taking EC and at the time she was too exhausted, distraught and humiliated to now drive to her local pharmacy where she may be known to ask for the treatment even if she had the money or health insurance to cover the cost. This is the reality of rape.
"I ask you, after all the progress we have made to protect the innocent victims of this crime and their quality of care, do we really want to undo years of work with one swipe of the pen? By doing so I believe we send the message that says after falling prey to this crime that you had no power to control we are now going to further inhibit your power to prevent carrying to term you attacker's child, or force you to submit to an abortion to avoid the consequence by limiting your access to EC. We understand that you may not have health insurance to pay for prenatal care or the abortion, not to mention the mental health services you will need to overcome this physical and emotional effects of this. We are very sorry about that, good luck to you and your family".
Carissa Simpson, Coordinator of Advocacy Services for the Sexual Assault Crisis Services at the Women and Families Center in Meriden, Middletown and New Haven testified: "I want to tell you about two recent experiences I have had assisting rape victims and their struggle to obtain emergency contraception.
"The first case was that of a young woman who was drugged and raped by an acquaintance. She was brought to the emergency within 48 hours of the assault. She was upset and confused, and a little woozy from the effects of the drugs her rapist had given her. I supported the victim through the rape kit and evidence collection exam, explaining the process to her as she was still groggy and sleepy. The victim was concerned about the possibility of pregnancy, so I advocated for the doctor to give her Emergency Contraception. The doctor stated that he had been ordered not to give EC under any circumstances. I pressed him on this because I knew the victim, in her present state, would be unable to go elsewhere to obtain the medication and she really only had a small window of time in which EC would still be effective for her. The victim also begged the doctor to give her at least a prescription for EC. After much pleading and tears on the part of the victim, the doctor gave her a prescription. By the time we were finished, her parents and the friend who brought her to the hospital were there to take her home and ensure she got the prescription filled. She may have gotten it just in time but was exhausted from the fight she
"More recently, an advocate that I supervise was called to the hospital to assist a victim with a disability who had been repeatedly raped by a neighbor who used a weapon and threats of violence during his assaults. These rapes had been ongoing for several months and it was only after speaking with advocates on out hotline, the victim felt safe and empowered to seek help within 72 hours of the final attack. The victim was extremely frightened but also exhausted and stressed from the violence she had endured.
"The exam took several hours and was a challenge due to the victim's disabilities. She was amazingly patient and got through the exam. The victim asked about EC but was not given any information about it. She was told that she would have to have a test done to determine if she was pregnant or ovulating. The victim was willing to comply, however she was unable to give a urine sample. She was asked to provide a blood sample which she felt was invasive and made her very emotional. She was told that the results of the blood test would be available in 24 hours. At some point during the visit, the victim was given antibiotics to treat any potential STDs, but in the confusion of the process, she assumed she had been given emergency contraception. It wasn't until two weeks later, when the victim read her medical records, that she found out she had never gotten EC and the hospital never called with the results of her blood test. The victim was in shock and was upset and devastated that she might have to endure a pregnancy by the mad who so brutally attacked her.
Unfortunately, the clock had run out on this victim. After suffering though months of vicious rapes and finally having the courage to come forward, this victim was denied a vital medicine that would have eased her mind and allowed her to begin her healing journey. I have since been counseling this woman who still hasn't gotten over the disappointment and betrayal she feels by the way she was treated at the hospital that day"
Amy Breakstone MD,Chair of the Division of Obstetrics and Gynoecology in the Department of Surgical Services in Bristol, testified: "Many have already spoken to the trauma that paralyses a woman recently assaulted, rendering her incapable of keeping a later appointment to obtain EC or of filling a prescription that would cost $45 at the local pharmacy. Consider also that woman, a victim of assault, who requires extended hospital stay for fractures, lacerations, or psychological trauma. It is too easy for the medical team to overlook the need to EC in that setting unless it is a standardized step in the care of the rape victim, that is, part of the rape kit, mandated by law.
"I also want to emphasize the EC is most effective at preventing pregnancy when provided immediately after insemination, though provision within three days is advertised so that women don't hesitate to present for care thinking it might be too late.
"The most important time to provide EC is actually when an ovulation predictor kit is positive. This detector of Luteinizing Hormone enables us to predict, when the LH is high, that ovulation might occur in the next 24 hours. This is the most important time to take advantage of EC's mode of action: to inhibit ovulation, inhibit tubular transport of the egg and sperm, and to interfere with fertilization. To inform a rape victim that her ovulation predictor kit is positive and that therefore her chances of conceiving from her assault are greatest, and then to refuse EC seems cruel punishment.
"My concern is also for the medical provider. We all know that it has been the unspoken habit of Emergency Department Physicians and Physician Assistants to provide ED in those hospitals where policy dictates otherwise. To reject this proposed legislation is to continue to place those providers in the untenable position where following what they know to be correct medical protocol is to place their jobs in jeopardy. Too often emergency facilities must find "a work around" or a "creative solution" in order to do what is medically right. Please provide these conscientious medial providers your support by passing SB 1343".
Gayle Weinstein, CT Advocacy Chair, on Behalf of the Connecticut Region of Hadassah, WZOA, testified: "Hadassah strongly believes a woman has the right, under the First Amendment of the U.S. Constitution, to make decisions about her reproductive health in consultation with her own religious beliefs, rather than have those decisions made for her. We support religious freedom, but feel that it is vital to find ways to accommodate religious observances in ways that do not interfere with access to health care and reproductive rights. If a victim of a sexual assault is not given accurate medical information, or is not offered what is generally considered the accepted standard of care, then she is virtually robbed of her ability to make her own informed decision.
"Further, as mothers, partners and women, Hadassah members believe all people should have equal access to health care services that met accepted standards of care. WE support this right regardless of race, religion, ability to pay or geographic location. After the violence of rape, a victim is too emotionally distraught, perhaps even unconscious, and may not be able to tell an ambulance driver which hospital to take them to. Of, they simply might not be aware of their options concerning hospital choice or medical treatment. This potentially limits the victim's access to health care".
Susan Lloyd Yolen, Vice President, Public Affairs and Communication, Planned Parenthood of Connecticut, testified: "Planned Parenthood supports this bill, which will offer enormous relief to women who have experienced one of like's greatest traumas. Other today will describe how emergency contraception works and discuss the reasons why the use of an ovulation test in screening for those eligible to receive this medication at a hospital emergency room is not the medical standard of care.
"Planned Parenthood would simply like to ask why, in 2007, in a state that treasures its moderate approach to social issues, we are even debating the reasonable, compassionate principles of this bill? This is the home of the Griswold v Connecticut Supreme Court decision that, in 1965, defined the constitutional right to privacy. Is it not part of our historical legacy to support reasonable means of empowering women to control their reproductive lives? Aren't victims of sexual assault at the very least entitled to defend themselves against the repulsive notion of a pregnancy resulting from the rape?
"You will hear statements today from some hospitals, implying they are willing to offer this pill to anyone who is not ovulating, but only after administering a notoriously unreliable blood or urine test in an effort to determine the hormone surge that precedes ovulation. We ask what rape victim, knowing that the only purpose of such a test would be to deny her they very medication that would most relieve her anxiety, would willingly offer her arm for the test? What other test do health care providers conduct for the sole purpose of withholding a service that the patient may want to obtain? Would a patient not be within her rights to assert that where she is in her menstrual cycle is a matter of personal privacy unrelated to the crime committed against her? Should she not expect to receive emergency contraception immediately upon admission to any hospital emergency department?
"Yet, relying upon a rape victim to proactively assert her rights after she has been brutalized, is really too much to ask. Compassion dictates, and even officials of the Catholic Health Association agree, that a victim of rape should be offered emergency contraception whether or not she is ovulating, is a urine pregnancy test shows that she is not pregnant. This seems like a reasonable approach. It is the approach adopted by the states of New York and New Jersey in recent years. It is the compromise that makes the most sense, medically and ethically".
Carolyn Treiss, Executive Director, NARAL Pro-Choice Connecticut, testified: "The only thing this bill has to do with abortion is that it prevents the need for one. I find is fascinating that in hearing on a bill about contraception, we've heard the word abortion more often. I don't know when exactly if happened, but sometime in the past few years, contraception became abortion in the minds and rhetoric of anti-choice organizations. And they've done a good job confusing the two, particularly in this building. But as you've heard from many distinguished members of the medical community today, the science is clear – abortion and contraception are not the same thing, and Plan B is contraception.
"Connecticut's people understand what this issue is really about and are not fooled by the opposition's inaccurate and inflammatory rhetoric. Just like voters in South Dakota and across the nation, they reject these kinds of extreme positions. A May 2006 Quinnipiac Poll found that 78% of voters and 74% of Catholics support 'requiring that all Connecticut hospitals, including Catholic hospitals, provide emergency contraception to rape victims.' Connecticut's people understand that birth control and pregnancy prevention are areas where both sides of the debate should be able to find common ground, and you should too.
"As the Quinnipiac poll demonstrates, Connecticut is a moderate state. Three of our neighboring states, Massachusetts, New York, and New Jersey, which are similar to us demographically and politically, have all agreed that ensuring a rape victims' access to emergency contraception is the right thing to do. Why is this so difficult for us, here in Connecticut in 2007?
"I urge you to reject the divisive rhetoric of opponent of this bill. I urge you to reject the junk science upon which their arguments are based. I urge you to respect women and our right to make our own health care decisions".
Jara N. Burnett and Birgitta Longnecker of The League of Women Voters of Connecticut testified: "Members of the League of Women Voters of Connecticut, . . . believe that all health care facilities that deliver emergency care in Connecticut should be required to offer emergency contraception as soon as possible after a rape has occurred. Victims of sexual assault deserve our compassion. This bill is consistent with the League of Women Voter's position to protect the right to make reproductive choices. We urge you to pass this important legislation."
Janet Alfano, graduate student of the UCONN School of Social Work, testified: "Women and girls who have just been sexually assaulted may not be aware of able, either physically of emotionally, to decide to which hospital they should go in order to get the proper treatment, which includes emergency contraception. The American College of Obstetrics and Gynecology, the American Medial Association, the American College of Emergency Physicians, and the World Health Organization all affirm that emergency contraception is the standard of care for rape victims. It is imperative that Connecticut hospitals follow the guidelines for compassionate care set forth by our nation's most prominent medical associations.
"Connecticut's hospitals may be the first point of contact for a rape victim after a sexual assault. The victim's treatment by health care professionals after the assault may have a substantial impact on her future recovery. Researchers from the University of Ohio conducted a study of the experiences with the medical system as hurtful or revictimizing. Rape victims who did not receive the morning after pill were more likely to rate their experience as negative."
Rev. Kristen J. Leslie Ph.D., Associate Professor of Pastoral Care and Counseling, Yale Divinity School, testified: Emergency Contraception is about providing the best medical options to girls and women after they have been raped. It is not about requiring girls and women to comply with a treatment they do not want. When hospitals refuse to provide emergency contraception as an optional treatment to rape survivors, they are refusing to provide good medical care.
"Emergency Contraception is about making abortions unnecessary after girls or women are raped. This is not about hospitals requiring women to have abortions. This is about how to respond to girls or women's need after they are raped. Emergency contraception decreases the need for abortions by making them unnecessary for rape survivors.
"Emergency Contraception is about preventing pregnancy. Twenty-five years ago is a Catholic woman was raped, the Roman Catholic Church supported her decision to have a surgical contraception procedure by means of a DNC. For a quarter of a century the Catholic Church has allowed such surgical interventions to prevent pregnancy. Emergency Contraception does the same thing without surgery. It is consistent with the Catholic faith to allow for medically indicated emergency treatments for rape survivors. Emergency contraception is not about interrupting pregnancy. It is about making pregnancy impossible.
"Emergency Contraception is consistent with family planning because it protects the health of girls and women by making pregnancies impossible that are the product of nonconsensual, violent and unwanted sex.
"Emergency Contraception is not about abandoning faith. It is about providing compassionate and faith-consistent care so that a girl or woman does not need to live in fear of getting pregnant from an act of violence".
Kelly Gigante, graduate student at UCONN, testified: "It is critical that emergency contraception be available at all hospitals in Connecticut. Having emergency contraception available at a pharmacy is not enough. A rape victim should not have to seek out an open and willing pharmacy after she has been discharged from the hospital after being raped. If the rape victim has to remain in the hospital because of her injuries, then one cannot dispute the absolute necessity for all hospitals to have emergency contraception available at all times. Emergency contraception now is 96% effective in preventing pregnancy when taken within the first twenty-four hours after the assault occurs, and the effectiveness rate drops to 61% between 48 to 72 hours after unprotected sex. Them American College of Obstetrics and Gynecology, the American Medical Association, the American college of Emergency Physicians and the World Health Organization all agree that offering emergency contraception as soon as possible after a rape is an undisputable medical standard".
Lois J. Uttley, M.P.P. Director, The Merger Watch Project, testified: "1. Catholic hospitals in other states are having no problem complying with laws requiring that they offer emergency contraception to rape victims. There is no reason why Connecticut's Catholic hospitals could not do so, as well.
"In my home state of New York, more than 40 Catholic hospitals are complying with such a law. Initial concerns raised by the New York State Catholic Conference were withdrawn once a clause was added to the legislation stating that 'no hospital shall be required to provide emergency contraception to a rape victim who is pregnant'. The Catholic hospitals in New York simply administer a standard pregnancy test, and if the result is negative, they immediately offer emergency contraception to the rape victim. Of course, if a rape victim was already pregnant prior to the assault – which is what a pregnancy test would show – she does not need emergency contraception. Knowing that her pregnancy is not from the rape will be a source of relief and comfort to her.
"Similar pregnancy test language was included in New Jersey's legislation and satisfied the Catholic conference in that state. It is also work noting that California, New Mexico, Washington and Massachusetts have all adopted laws similar to those being proposed here in Connecticut – without the pregnancy test clause in New York and New Jersey – and Catholic hospitals in those states appear to be complying with no problems.
"2. The ovulation test protocol being used by Connecticut's Catholic hospitals is based on a deeply-flawed understanding of basic reproductive biology and what an ovulation test can show.
"An open letter being delivered to the Connecticut State Legislature form nationally-recognized physicians, scientists, and public health experts explains these flaws in detail. I will simply summarize here. An ovulation test, if working perfectly, would only show whether a woman is about to ovulate or has recently ovulated. It cannot show whether there is a fertilized egg present, which is what Connecticut's Catholic Bishops are trying to detect. There is no medical test in existence that can determine the presence of a fertilized egg within five days after unprotected intercourse, which is the outside time frame in which emergency contraception is effective.
"Moreover, ovulation tests are notoriously inaccurate. Any woman who has ever used one to try to become pregnant could have told that to Connecticut's Catholic Bishops. The test can be thrown off by such factors as when the urine sample is taken – it's best first thing in the morning – whether the woman has been drinking and whether she has taken certain antibiotics.
"3. The ovulation test protocol being employed in Connecticut is extreme and, according to prominent Catholic health ethicists, goes well beyond what is required by Catholic teaching.
"Ron Hamel, the senior director for ethics of the Catholic Health Association of the United States, has written that use of an ovulation test goes too far – that it 'limits' what is actually allowed under the Directive No. 36 of the Ethical and Religious Directives for Catholics Healthcare Services, which are issued by the United States Conference of Catholic Bishops. Here is what Hamel said: "Nowhere in the directive does it state that Catholic health care providers must refrain from administering emergency contraception to women who are about to ovulate of who have ovulated recently. In fact, Directive 36, explicitly affirms that medications can be administered to prevent fertilization, which occurs after ovulation. By limiting the administration of emergency contraception to situations in which the woman has not yet ovulated or is past the early post-ovulary phase of her menstrual cycle, the ovulation approach unnecessarily restricts the moral options available to women who are at or near the time of ovulation and wish to prevent potential conception.
Renee C. Redman, of ACLU of Connecticut testified: "The ACLU of Connecticut supports laws that ensure that sexual assault survivors receive comprehensive care in the licensed health care facilities that provide emergency treatment. The ACLU of Connecticut opposes any amendment that would include a 'religious exemption' or 'refusal clause' exempting religiously-affiliated health care facilities in Connecticut from providing emergency contraception to all rape victims.
"A rape survivor must be offered EC during her initial exam.
"Every day, women who have been sexually assaulted seek treatment in emergency care facilities. Among their concerns is the possibility of pregnancy. Emergency contraception (EC or the 'morning after pill') is a safe and reliable method to prevent pregnancy after unprotected intercourse, including a sexual assault. The American College of Obstetricians and Gynecologists and other medical groups recommend that emergency facilities offer EC to all sexual assault patients who are at risk of pregnancy.
"EC is basic health care for women who have been raped. Time is absolutely critical to a rape survivor who wishes to prevent pregnancy. The effectiveness of EC diminishes with delay. Experts stress that EC is most effective the sooner it is taken, with effectiveness decreasing every 12 hours. Therefore, it is vital that emergency care facilities offer EC to rape survivors during their initial exams.
"A rape survivor who does not obtain EC in the emergency room must track down EC on her own. The Food and Drug Administration's recent action to increase availability of EC by making it available without prescription to women 18 and older who present government-issued proof of age does not address a sexual assault survivor's immediate needs. Some sexual assault survivors will still need to get a prescription from a physician and all women will have to find a pharmacy that stocks the medication. Most importantly, a sexual assault survivor is already in crisis and should not have to seek out additional medical care to prevent pregnancy. In addition to the emotional burden this imposes, the rape survivor would have increased risk of pregnancy due to the delay inherent in having to track down EC, and in some cases she would be unable to obtain EC at all.
"Raised Bill No. 1343 would not violate the constitutional rights of religiously-affiliated facilities that provide emergency health care services.
"The inclusion of a refusal clause for religiously-affiliated health care facilities is neither constitutionally requires nor good policy.
"As currently interpreted by the U.S. Supreme Court, the Free Exercise Clause of the First Amendment to the U.S. Constitution does not relieve an institution form compliance with a 'valid and neutral law of general applicability' because it conflicts with the institution's religious beliefs. Employment Division v. Smith, 494 U.S. 872, 879 (1990). A religiously-affiliated health care facility therefore has no federal constitutional right to refuse to abide by a general law requiring it to provide EC to sexual assault survivors upon request.
"No religiously-affiliated health care provider has brought a legal challenge to a state law requiring that EC be provided upon the request of a rape survivor. However, courts in two states have recently held that the Constitution does not require a religious exemption to reproductive health mandates. See Catholic Charities of Sacramento, Inc. v. Superior Court, 85 P.3d (Cal) cert. denied, 543, U.S. 816 (2004) (No. 03-1618); Catholic Charities of the Diocese v Serio, 859 N.E.2d 459 (N.Y. 2006). Both cases – one in New York and the other in California – were challenges by religiously-affiliated employers to state requirements that employers who provide prescription insurance coverage include coverage for prescription contraceptive drugs and devices. Both laws exempted a narrow coverage category of religious employers, such as churches, mosques, and synagogues, but not religiously-affiliated charities and other social service organizations. The exemptions were based on the facts that the purpose of religious employers is the inculcation of their faith, and that they primarily hire and serve people who share the tenets of that faith.
"Immediately upon passage, religiously- affiliated social service employers in both states, including Catholic Charities, who did not meet the statutory definition of religious employer, sued the state. They claimed a constitutional right to be exempted from compliance with the contraceptive equity law. In both cases, the highest state courts soundly rejected the challenges and upheld the laws.
"Neither court questioned the sincerity of the employers' religious beliefs. They concluded that the laws do not violate the Constitution because they are facially neutral, generally applicable laws – they apply to all employers who offer health insurance and do not target religious practices or beliefs.
"Just as employers with religious objections may be legally requires to offer insurance coverage for contraception, health care institutions with a religious objection can be legally requires – consistent with the Constitution – to ensure that sexual assault survivors receive comprehensive treatment, including the offering of emergency contraception.
"Exempting religious-affiliated health care institutions with a religious objection form compliance with Raised Bill No. 1343 is not good policy. The Bill is facially neutral – it applies to all health care facilities that provide emergency treatment to rape victims. The purpose of the Bill is to ensure that all rape victims are provided the compassionate care and psychological relief they deserve and guarantee that they are not denied health care options based on where they live of the hospital to which they are taken following the attack.
"Religiously – affiliated health care facilities are not religious organizations.
"Both the New York and California courts also rejected the employers' claim that the laws intrude into the autonomy of the religiously – affiliated organizations in violation of the Constitution. They ruled that, although the state may not dictate the tenets of faith or control the relationship of a church to its ministers, the state may enact labor laws to protect the employess of the religiously – affiliated organizations, even if those laws conflict with church doctrine. They concluded that the laws implicate relationships between non-profit religiously-affiliated corporations and their employees, some of which do not belong to the particular faith. As the California Supreme Court stated, "[o]nly those who join a church impliedly consent to its religious governance on matters of faith and discipline." Catholic Charities of Sacramento, Inc. v. Superior Court, 85 P.3d77.
"Just as Catholic Charities is not a religious organization, religiously – affiliated health care facilities are not religious organizations and should not be exempt from a law requiring immediate provision of EC to rape victims. The purpose of religiously – affiliated health care facilities is to provide health care – not the inculcation of religious values – to the general public. They not only employ many people who do not share their religious beliefs but primarily serve people who do not share those beliefs".
Dr. Frank Davidoff, MD, MACP, Editor Emeritus, Annals of Internal Medicine, Executive Editor, Institute for Healthcare Improvement, testified: "The Catholic hospital's protocol is not based on the existing medical evidence. It also compromises patients' rights to the highest standard of medical care.
"According to the Connecticut Catholic Conference, the Catholic hospitals' protocol will deny Plan B to any woman who is deemed to be ovulating, based on a spot urine test. According to several scientific studies, however, that test has been proved to be highly inaccurate. The Catholic hospitals' protocol also makes it clear that the decision to deny care is based on the assumption that once a woman is 'in the ovulation stage of her cycle, Plan B cannot have a contraceptive effect', and goes on to assert that 'In these cases, the only objective of administering Plan B is to impede the implantation of a fertilized ovum.' Those assumptions are, or course, not correct because there's another mechanism by which Plan B can and does prevent pregnancy in the ovulation stage of a woman's cycle – namely, it prevents sperm from ever reaching the egg by thickening the cervical mucus.
"A hospital protocol for the care of rape victims that is based on an incomplete understanding of women's reproduction, lack of knowledge about the mechanisms of action of Plan B, and a laboratory test that is grossly inaccurate is morally and ethically unacceptable.
"Let me conclude by reminding you of one of the fundamental ethical principles in medicine: respect for patients' autonomy. That principle means that patients have the ultimate right to determine what happens to their own bodies. By refusing to provide Plan B – a safe, effective, approved, and legal therapy – to some patients, the Catholic Hospitals are violating one of the patients' most fundamental rights. The decision whether or not to receive that therapy rightfully belongs with the patient, not with a flawed protocol based on flawed information.
Melissa Berardi of Safe Haven testified in support of SB 1343
Sara Ferah testified in support of SB 1343
Matthew Wagner testified in support of SB 1343
NATURE AND SOURCES OF OPPOSITION:
Mary Anne Sprague of Bethlehem CT, testified: "The number of 'necessary' abortions is ZERO. Rape and incest are similar in the sense that both are criminal acts. In our system of justice, we punish the criminal. We do not punish the victim, nor do we punish the criminal's children. We are told, however, offering the victim a post-rape drug is the compassionate thing to do. And Connecticut subsidizes the post-rape drug. Planned Parenthood of Connecticut also urges healthcare providers to actively enhance access of the post-rape drug pill by including it in all rape kits. Planned Parenthood Federation of America has a monetary interest in this bill as five of their affiliates made equity investments in Plan B with the maker of the post-rape drub, Barr Pharmaceuticals, and have made millions in profits.
"This bill is also a setback in religious freedom. Where are the rights of the taxpayers, not to pay for unhealthy and morally objectionable services? And there is no refusal clause for contraceptives in Connecticut's law's and policies addressing contraception. So where are the rights of the individual Christian physicians and Catholic healthcare facilities not to provide or refer for morally objectionable services? And where are the rights of Catholic healthcare providers to participate in the market of health services by providing morally acceptable and ethical healthcare alternatives without the threat of being shut down by losing state and federal funding if they don't comply?".
Thomas Davis, testified: ". . . The argument about delay and transfer has also lost its teeth. If 2006 the Federal Drug Administration authorized the over the counter sale of Plan B. There is no longer any need for transfer to another hospital. No need for a prescription. No need to call a doctor. Anyone can dispense it. Counselors from sexual assault services can carry it and provide it. Police can carry it and provide it.
"A supply can be maintained in many ways by public authorities without requiring a Catholic hospital to violate it's principles. Why would anyone, knowing the enormous contribution Catholic hospitals make to public health, want to target their most basic ethical and moral principles for the sake of a problem that does not exist?
"Finally, as I understand it from a survey of Catholic Hospitals available at the Connecticut Catholic Conference website, not one rape victim had been denied Plan B in a Catholic hospital since the inception of the new protocol. Zero.
"The ugly and vicious reality of rape typically leaves the victim desolated. Treatment at Catholic hospitals is compassionate and appropriate. I urge you to leave it alone and recognize that no pressing public health or policy issue requires action of the type proposed by this bill".
Robert E. Muckle Sr., of Waterbury, testified: "The Morning After Pill is a high dosage of the Birth Control Pill; there are potentially harmful effects on young women, especially on still-developing adolescent girls; some of the side effects are nausea, vomiting, breast tenderness, ectopic pregnancy and blood clot formation. Emergency Contraception also leaves a woman vulnerable to sexually transmitted diseases (STDs) including AIDS.
"With all of this information available, it is hard to imagine how or why the FDA would allow the Pill of Morning After Pill to be available, let alone over the counter. It is hard to figure out how you could support Plan B for anybody, let alone sexual assault victims. Its purpose is to destroy a developing human being from its mother's womb".
Cindy Speltz of St. Paul, Minnesota, testified: "While I was asleep in my own bed, a male person emerged from the bedroom closet in the middle of the night and proceeded to force himself on me against my will. Three and a half months later, I discovered I had conceived a child. My father kicked me out into the street while I was pregnant.
"All this happened only 18 months after Roe v Wade became effective in the United States.
"I was literally homeless, motherless, penniless, jobless, a teenager, alone, and pregnant by way of sexual assault. Also, I have a hereditary congenital physical disorder that is incurable. I had been told that I was the 'perfect candidate' for an abortion. In the eyes of the world, my unborn baby's life was condemned.
"On June 14, 1975, I gave birth to a beautiful baby girl. . . .
"By my own, raw, personal experience, I can speak firsthand as an American: in our civilized nation there is really no logical or valid reason to ever terminate a baby's life.
"In the first several days after my sexual assault crisis, I was absolutely in no condition, mentally or emotionally, to make any long term, life-altering decisions that would affect the rest of my life by submitting to the use of a chemical abortifacient such as 'Plan B'.
"Personally speaking, if I had granted permission and deliberately participated in my own baby's death, that would have been the real tragedy I could never recover from as a victim of rape who lost a baby.
"Giving birth to Jenni and raising her myself became a gradual healing process for me. I was able to recover and move on in my life. How could I deny my own child's life because of a violation someone else did to me?
"She was a victim as well.
"I have no regrets – only my gratitude for her existence. I did the right thing that was in her interest as well as my own. I now cherish the fruits of great love in my life – that of my 2 grandbabies."
Jennifer Maas of St. Paul, Minnesota testified: "If this bill had been enacted 32 years ago, when my mother suffered a sexual assault, I, and my son, might not be here today . . .
"I first began to recognize that I had a story to tell when I was attending Junior High School. I distinctly remember one day as I walked down the hall with come friends and one said 'I don't like abortion, I think it is wrong. . . but we have to keep it legal for cases of rape and incest'
"These words hit the very core of my being.
"My mother had been slowly revealing the circumstances of my conception to me over the years and by the time I was 13, I understood and had come to grips with the reality that my biological father was, essentially, a rapist. He had violated my mother against her will.
"When my mom found out that she was pregnant the only advice she was given was to discard the 'products of conception'. Needless to say, I am eternally grateful that she heeded that still small voice in her heart that told her that the life growing within her had a purpose and did not merit death/
". . . If my mother had been offered the abortifacient 'Plan B' in the distressing and traumatic aftermath of suffering a criminal sexual assault, especially if it is offered under the guise, as it is proposed in this bill, of merely 'preventing a pregnancy.' I probably wouldn't be here to tell you – I am so glad to be here.
". . . It is crucial that every citizen realize that a person's dignity is not founded on whether he or she is wanted or unwanted, planed or unplanned – our dignity is rooted in something far greater than that. The circumstances of my, your, or anyone's conception, does not determine quality of life"
Barry Feldman, Senor Vice President – General Counsel of Saint Francis Hospital and Medical Center, testified: "Insofar as the Bill before the Committee deals with what is truly 'emergency contraception,' the Catholic hospitals are not in disagreement. In fact, the Sexual Assault Protocol for Connecticut Catholic Hospitals permits Catholic hospitals to provide hormonal medication when that medication can actually act to prevent contraception.
"However, insofar as the Bill requires the administration of hormonal medication at a time in the woman's cycle when that medication cannot act to prevent contraception but can only act as an abortifacient, then the Bill as written would require Catholic hospitals to perform abortions, which are contrary to Catholic religious and moral teachings.
"In particular, the Sexual Assault Protocol for Connecticut Catholic Hospitals (the 'Protocol') requires that Catholic hospitals:
"1. facilitate prompt, compassionate examination and treatment to victims of sexual assault;
"2. provide emergency contraception ('Plan B') when the woman in the phase of her cycle in which Plan B can have a contraceptive effect by preventing ovulation;
"3. in the extremely rare cases in which the woman is already in the ovulation stage of her cycle so that Plan B cannot have a contraceptive effect, inform the woman of the reasons why the Catholic Hospital cannot provide Plan B;
"4. inform the woman of other sites in the community that may offer Plan B;
"5. provide the woman with such clinical technical or factual information that the patient requests or may need to make a decision whether to continue to receive treatment at the Catholic hospital; and
"6. facilitate the transfer of the patient if the patient requests.
"The Protocol requires that a pregnancy test be administered to all women who are the victims of sexual assault.
"If the pregnancy test indicates that the woman is pregnant, then hormonal medications would not be administered by a Catholic hospital (nor would they be administered by any other hospital) because it is obviously too late for their anovulatory effect. These tests only provide evidence of a pregnancy that was already in existence at the time of the sexual assault.
"This policy is consistent with the policies of both Catholic and non-Catholic hospitals, in Connecticut and elsewhere.
"If the pregnancy test does not indicate that the woman is pregnant, and if the medical history of the woman indicates that she may be in the ovulating stage of her cycle, then the Catholic hospital will conduct a luteinizing hormone urine dip test (LH Test) to determine if the woman id about to ovulate or has already ovulated. The LH Test gives an immediate positive or negative indication, and is a scientifically reliable test for determining whether a woman is in the ovulation stage of her cycle. Another test previously used, a progesterone blood level test, is less precise and takes more time, and therefore is not recommended.
"The LH Test is given to determine whether the administration of Plan B would have a contraceptive effect.
"If the LH Test indicates that the woman is not in the ovulation stage of her cycle, the Plan B can act as a contraceptive by preventing ovulation, and Catholic hospitals will provide Plan B in such cases.
"If the LH Test indicates that the woman is already in the ovulation stage of her cycle, then Plan B cannot have a contraceptive effect. In these extremely rare cases, the only objective of administering Plan B is to impede the implantation of a fertilized ovum, which is abortion that the Catholic hospital cannot morally perform directly or in cooperation with others.
"The mechanism of Plan B that prevents the implantation of a fertilized ovum, which is abortion, is confirmed on the manufacturer's web site that says, 'Plan B may also work by preventing it (the fertilized egg) from attaching to the uterus (womb).'
"Catholic hospitals in other states, such as Pennsylvania and Illinois, follow a protocol similar to Connecticut's. In fact, the protocol followed by Connecticut's Catholic hospitals is endorsed by the National Catholic Bioethics Center and is becoming the mainline standard for Catholic health care nationally. A national standard was still under review, and not in place, when New York and New Jersey adopted legislation concerning the distribution of Plan B to rape victims.
"Legislation adopted in Pennsylvania recognizes and respects the religious beliefs of Catholic hospitals by exempting those hospitals from requirements to provide hormonal medications to victims of sexual assault. Legislation adopted in Illinois does not require hospitals to provide emergency contraception, but does require all hospitals to follow a protocol similar to that of Connecticut's Catholic hospitals that ensures that victims of sexual assault receive accurate information regarding the indications, counter-indications, and availability of emergency contraception.
"The Protocol followed by Connecticut's Catholic hospitals is the result of a thoughtful and discerning process that reflects a desire to provide compassionate care and treatment to victims of sexual assault in conformance with the limits imposed by Catholic religious and moral beliefs.
"Catholic religious and moral beliefs hold that a human being exists from the moment of conception, and that that human being is entitled to all of the dignity and respect to which every other human being is entitled.
"The Constitutional and legal rights to hold and practice one's religious and moral beliefs without interference from the State are as important as any other Constitutional or legal right.
"Religious liberties are one of the principal, fundamental rights established by the United States and Connecticut constitutions, as well as by the Connecticut Religious Freedom Act (C.G.S. Section 52-571b).
"The Religious Freedom Act prohibits the state from burdening a person's exercise of religion unless the State demonstrates that application of the burden is in furtherance of a compelling governmental interest, and is the lest restrictive means of furthering that compelling governmental interest.
"These requirements cannot be established without reliable, corroborated evidence that is more than anecdotal accounts and hypothetical examples.
"There is a fallacy that Plan B must be administered in a hospital. The Plan B pill, which is about the size of an aspirin, need not be administered in a hospital, is readily available on a timely basis in pharmacies, without prescription, and in numerous clinics. Additionally, each of Connecticut's four Catholic hospitals is located in an urban area just minutes from other hospitals where the medication is available.
"Not all hospitals in Connecticut provide all services. Patients who cannot receive care or services at one hospital are routinely transferred to other facilities for treatment of emergency conditions such as cardiac failure, severe burns, and neonatal, neurosurgical, and other conditions. If there is ever a need to transfer a victim of sexual to another hospital because the Catholic hospital could not provide Plan B, then such a transfer would be hardly distinguishable from, and no more burdensome than, the many other situations in which patients with emergency conditions are routinely transferred from one hospital to another.
"Connecticut's Catholic hospitals do not believe that there is a sufficiently compelling or indeed any basis for the State to force the hospitals to violate their religious beliefs by performing abortions, and unless and until the General Assembly, through an objective process, has assembled the evidence necessary satisfy Constitutional requirements and the conditions set forth in the Religious Freedom Act, the State should not and cannot force the hospitals to violate their religious beliefs.
"If and to the extent that the General Assembly determines that non-Catholic hospitals do not provide hormonal medication in a manner that serves what the General Assembly believes to be compelling State interests, then those interests can be addressed by requiring non-Catholic hospitals to provide such medication and by exempting Catholic hospitals form the requirement. Addressing the issue in this manner is exactly what is contemplated when the Religious Freedom Act requires that the State utilize the 'least restrictive means' to address an issue before or when burdening one's exercise of religion.
"In this regard, there are two important reasons why the New York and New Jersey legislation are not relevant to the situation in Connecticut. First, neither New York nor New Jersey has legislation similar to Connecticut's Religious Freedom Act, and therefore there is a higher hurdle in Connecticut than in New York and New Jersey to lawfully impose burdens on the Catholic hospitals' exercise of their religion. Second, the legislation in those states was passed prior to the act by the U.S. Food and Drug Administration (FDA) in 2006 to permit the dispensing of Plan B over the counter without prescription, thus making the requirement that the State use the 'least restrictive means' before it burdens the Catholic hospitals' exercise of their religion.
"The failure of Raised Bill 1343 to include an exemption for Catholic hospitals with respect to what they consider to be god and ethical medicine threatens the religious liberties of those hospitals. A threat to any individual's or organization's religious liberties is a threat to everyone's religious liberties".
Ronald Thomas, M.D., F.A.C.E.P. Chairman, Emergency Department, Hospital of Saint Raphael testified: "The Hospital of Saint Raphael's mission is caring. . . . All patients, including victims of sexual assault, are treated with dignity and respect, and although the first priority is to respond to the physical and acute clinical needs of the patient, we also respond to the mental health and spiritual needs of all of our patients.
"When a patient arrives at the hospital following a sexual assault, Saint Raphael's staff first focuses on caring for the physical and emotional needs associated with this trauma. A sexual assault kit is used to gather evidence, and patients are offered supportive help from Saint Raphael's social services department. If the patient agrees, the Rape Crisis Center is contacted on the patient's behalf for additional assistance.
"The Hospital of Saint Raphael follows the Ethical and Religious Directives for Catholic Health Care Services, including directive #1 to provide healthcare to those in need. Using these same directives, Saint Raphael's clinical staff administers emergency contraception to prevent ovulation in a woman who has been raped if, after immediate testing, it can be determined that she is not pregnant or not ovulating. Statistics regarding sexual assault victims cared for at Saint Raphael's are summarized below:
"January 1, 2006 through September 30, 2006
"Rape victims cared for in the emergency department: Of those: Patients who desired and received emergency contraception: 5 Patients who were post-menopausal, on birth-control pills, or refused treatment: 6
"Of the 11 patients cared for, 5 were also assisted by an outside rape crisis counselor. All patients, including victims of sexual assault, are provided with factual, clinical information regarding the methods and effectiveness of treatment options, to assist the patient in making decisions regarding treatment. If emergency contraception cannot be administered at Saint Raphael's and the patient wishes to receive this medication, referrals are made to a community physician or to an appropriate agency by our emergency department clinical staff. Over-the-counter emergency contraception is also available to patients 18 years of age and older.
"The above statistics and the policies and procedures that we have in place to assist all victims of sexual assault raise the question as to the need for S.B. 1343, An Act Concerning Compassionate Care for Victims of Sexual Assault. We already provide compassionate care to all patients, including victims of sexual assault, and have the appropriate protocols and mechanisms in place to do so.
Bill O'Brien President of Connecticut Right to Life Corporation testified: "Each multi-celled animal begins its life as a one celled zygote. Each zygote is a type of being. If the one celled zygote is a human cell, then, since it is a human, and it is a being, it is a human being. Every reputable biology book in the world agrees this is a scientific fact.
"If a human zygote is a human being, and it is, then it is also a human being in each successive stage, such as blastocyst, embryo, fetus, and so on. If you kill a human zygote, blastocyst, embryo, or fetus, you kill a human being.
"On the wed site of Duramed, a subsidiary of Barr Pharmaceuticals, manufacturer of 'Plan B', it states three modes of action by 'Plan B'
"1 – stopping the release of the egg from the ovary
"2 – preventing the fertilization of the egg by a sperm
"Both of these methods may kill human cells, but not human beings, thus they are contraceptive in action.
"However, number 3 says 'Plan B' prevents 'it from attaching to the uterus (womb)'
"That 'it' that is prevented from attaching to the uterus, is a newly created living, human being in the zygote, blastula, or embryonic stage of development. If this very young human being is prevented by 'Plan B' from attaching to the uterus, he or she will die.
"My second point takes issue with the use of the word 'compassion' in using 'Plan B' to possible kill a newly conceived being.
"This book [Victims and Victors] is based on a study of 164 pregnant rape victims. Contrary to public opinion, this study, and the only other one like it, both showed upwards of 73% of pregnant rape victims rejected abortion. Contrary to feeling 'compassion', those women in the study who did resort to abortion, including many who felt forced into having one, described the abortion as being raped a second time, only this time by their own doing. Others describe the abortion as 'medical rape'. Some said they could get over the sexual rape, but had a harder time forgiving themselves for having the abortion and taking their child's life.
"'Plan B' is not 'compassionate' care for a sexual assault victim who has, or may yet, conceive a child. In their own words, it is 'medical rape'".
Anolan Drago testified in opposition to SB 1343
Luigi Iacono testified in opposition to SB 1343
Rosemare Lewis testified in opposition to SB 1343
Reported by: Heather A. Dorsey, Assistant Clerk
Date: March 20, 2007