Hawaii lawmakers have been introducing legislation for nearly 20 years to ensure that women who are sexually assaulted have access to emergency contraception in emergency rooms — and many believe this could be the year it passes.
"In this day and age, in 2013, to be denying someone who has been raped access to all of the information and the standard of care is unconscionable to me," said Sen. Roz Baker (D, West Maui-South Maui), vice chairwoman of the Senate Health Committee. "We really need to make sure that it’s across the board."
House Bill 411 and its companion, Senate Bill 1109, would require emergency rooms statewide to offer emergency contraception to rape victims. The House bill was passed by the Senate Health Committee, but the Senate bill has not yet been taken up in the House.
The measures would bring isle hospitals into compliance with the policies of the American Medical Association and American College of Obstetricians and Gynecologists, which say informing sexual assault victims about pregnancy-preventing emergency contraception and offering it to them should be the standard of care.
Few Hawaii hospitals have clear policies on the issue.
The Coalition for Compassionate Care for Sexual Assault Victims conducted a survey in 2010 in which 26 emergency departments across the state were asked whether they had an emergency contraception policy. Fifteen hospitals returned surveys. Of those, only four had a policy to always offer emergency contraception to sexual assault victims.
Three hospitals reported that they never dispense emergency contraception.
Currently, that’s within the law.
"They’re not providing good health care by doing that, but currently, no, they’re not breaking any laws," said Katie Polidoro, director of public affairs and government relations for Planned Parenthood of Hawaii. "That’s why we need this bill to pass."
In 2005, the U.S. Food and Drug Administration approved the over-the-counter sale of the emergency contraceptive drug Plan B to women 18 years and older, and in 2009 allowed women at least age 17 to buy the drug without a prescription.
With a prescription, there is no age limit.
Nearly 1 in 5 women are sexually assaulted in their lifetime, according to the Centers for Disease Control. About 42 percent are under age 18 at the time of the attack.
According to Crime in Hawaii, an annual report by the attorney general, there were 353 reported forcible rapes in 2011, but the Department of Justice estimates that 65 percent of rapes and sexual assaults went unreported between 2006 and 2010.
An estimated 5 percent of women who are raped become pregnant.
Members of religious communities and others morally opposed to emergency contraception have spoken in strong opposition to what have been dubbed "compassionate care" bills because, they say, they are tantamount to abortion.
"We believe that life begins at fertilization," Deacon Walter Yoshimitsu, executive director of the Hawaii Catholic Conference, told the Senate Health Committee Monday.
According to the FDA, approved emergency contraception drugs such as the one marketed as Plan B One-Step work to prevent pregnancy primarily by stopping the release of an egg or not allowing sperm to reach the egg, and it "may prevent a fertilized egg from attaching to the womb."
While the womb implantation issue is subject to debate, Polidoro said the bottom line is that the pill "prevents pregnancy from happening," adding, "it prevents the need for abortion; and it’s the standard (of care) for sexual assault victims in emergency rooms across the country."
Opponents such as the Hawaii Catholic Conference, civil rights lawyers and the Hawaii Family Forum have testified in support of an individual exemption to the proposed law because they are concerned that emergency-room workers will not be protected under federal conscience exemptions.
But those exemptions apply only to abortion and sterilization procedures, and the bills state that "emergency contraception is not an abortion pill, nor does it cause any abortive process to take place."
Patricia McManaman, director of the state Department of Human Services, told senators she’s confident that current Hawaii civil rights law would cover workers who request not to be required to inform sexual assault victims about emergency contraception or dispense the pill.
Rep. Sharon Har (D, Kapolei-Makakilo), vice chairwoman of the House Judiciary Committee, said she supported an amendment proposed by Rep. Richard Fale (R, North Shore) that would have permitted a religiously affiliated hospital or a hospital legally bound by a religious or ethical directive to take sexual assault victims to another hospital after stabilizing them, provided the hospital covers the cost of transport.
However, Rep. Della Au Belatti (D, Tantalus-Makiki), chairwoman of the House Health Committee, said allowing transport to another hospital would cause undue harm to victims.
"I really wanted to have the best care at the very first place they may stop or report to," she said.
St. Francis Healthcare System of Hawaii, which ran the former Hawaii Medical Center West campus before it closed in 2011, sought exemptions from compassionate care bills in the past because the hospital contended that a law requiring it to dispense emergency contraception would force it to violate its religious tenets against abortion.
The Queen’s Medical Center finalized a deal in December to purchase the facility and reopen it as Queen’s Medical Center-West Oahu next year, but has stated on its website that it agreed with St. Francis Healthcare to follow the ethical and religious directives for Catholic health care services.
The contract, however, is confidential, so lawmakers are unsure what effect, if any, an emergency contraception law would have on the hospital.
While many are confident the sale will continue uninterrupted, Har said she isn’t so sure.
"Without understanding what were the terms of the agreement, I do have concerns about this bill," Har said. "Because worst-case scenario: For all we know the land could revert back to the sisters of St. Francis because they’ve now violated a covenant, and now Queen’s West doesn’t open. Or another worst-case scenario (is) they say, ‘You know what? This applies only to emergency rooms. Because we don’t want to be held in violation of our agreement with the sisters, we will now not open an emergency room.’ I mean there’s a myriad of things that could happen."
Belatti said that if Queen’s were concerned about the bills, it likely would have come forward to testify.
