June 3, 2026 · Health Committee · 10,000 words · 11 speakers · 101 segments
Chairman, or Clerk, will you take the roll? Chairman Huffman?
Here.
Vice Chair Johnson?
Here.
Ranking Member Liston?
Here.
Senator Ingram?
Here.
Senator Manchester excused. Senator Rogner excused.
Senator Romanchuk?
Here. We'll act as a committee before we get started. I hope Senator Manchester is watching and congratulate her on her birth the week before last. She's doing well, so I'm very happy for her. First up, the approval of minutes from the last meeting. Are there any additions or corrections or concerns? Seeing none, the minutes will stand as written. Next up, the fourth hearing with no testimony on Senate Bill 230. Senator Romancheck authorizing physician. The chair recognizes Senator Romancheck for a motion.
Thank you, Mr. Chairman. I move to adopt substitute bill number 1120-5.
The substitute bill is in order. Will you explain the substitute bill?
Thank you, Mr. Chairman. This bill authorizes pharmacists to provide treatment and related services for influenza, strep throat and COVID-19, but does not permit a pharmacist to treat RSV. It limits patients to those that are five years or older. In place of rulemaking, this bill directly requires the pharmacy board to develop the protocol and will set procedures for developing the protocol outside the rulemaking process. It requires the pharmacy board to review the protocol every two years and make revisions as the board considers necessary. It requires the pharmacy board to inform all individuals licensed by the board when the initial or revised protocol is finalized. It requires the pharmacy board to maintain a copy of the current protocol on its website. It permits, rather than requires, the pharmacy board to adopt rules as it considers necessary to implement these provisions. And finally, the sub-bill will also grant the Pharmacy Board and the Medical Board qualified immunity from civil liability for harm allegedly arising from a pharmacist's use of the protocol.
Is there any questions about the substitute bill? Is there any objection to the substitute bill? Seeing none, the substitute bill is adopted and will be accepted. That will end the fourth hearing on Senate Bill 230. First up, sponsor testimony on Senate Bill 274. Senators Serena and Brenner prohibiting minor mental health services without parental consent.
Thank you very much, Chairman Huffman, Vice Chair Johnson, Ranking Member Liston, and members of the Senate Health Committee. Thank you for the opportunity to provide sponsor testimony on Senate Bill 274. I'd also like to thank my joint sponsors, Senator Serino, for his partnership on this legislation. At its core, Senate Bill 274 is about one fundamental question. Who should be responsible for raising a child, the parent or the government? For generations, the answer has been clear. Parents bear the primary responsibility for upbringing, education, health, welfare, and care of their children. They are legally responsible for their children financially responsible for their children and morally responsible for their children When a child faces challenges whether academic physical emotional or psychological parents are expected to be the first in line of support and guidance Last General Assembly, this body passed House Bill 8, the Parents' Bill of Rights, and Governor DeWine signed it into law. The General Assembly affirmed that parents possess a fundamental right to make decisions regarding the upbringing, education, and care of their children. House Bill 8 recognizes the parents should be informed with significant issues arise affecting the child's well-being. The law requires parental notification when a student experiences issues involving mental, emotional, and physical health, including suicidal ideation, self-harm, severe anxiety, depression, or other significant mental health concerns. The reason is simple. These are serious matters with potentially life-altering consequences. Yet despite the clear intent. Intent of House Bill 8, Ohio law still contains provisions that permit certain mental health services to be provided to minors without parental knowledge or involvement. Senate Bill 274 eliminates that inconsistency and aligns Ohio law with the policy this General Assembly has already adopted. The premise behind this bill is straightforward. Parents cannot fulfill their responsibilities if they are intentionally excluded from decisions involving their own children. Senate Bill 274 does not prohibit mental health services. It does not prevent schools from identifying students who may need help. It does not prevent children from receiving necessary treatment. What it does ensure is that parents remain informed and involved in significant decisions affecting the mental health and well-being of their children. There is also a broader health care principle at stake. Ohio law generally requires parental involvement and consent for significant medical decisions involving minors. Parents are expected to participate in decisions involving surgeries, medications, treatment plans, special referrals, and ongoing medical care. Mental health should not be treated as somehow separate from health care. In fact, successful mental health treatment often depends upon parental participation. Parents schedule appointments, provide transportation, monitor symptoms, help ensure treatment recommendations are followed, manage medications when prescribed, and provide daily support and stability in the home environment. As policymakers, we should ask a simple question. If parents are expected to be involved in virtually every other significant health care decision affecting their child, why should they be excluded from decisions involving a child's mental health? Mental health is health care. Senate Bill 274 recognizes that reality and promotes a collaborative approach in which health care providers, schools, and families work together for the benefit of the child. I also want to address a concern that is frequently raised whenever parental involvement is discussed. Nothing in Senate Bill 274 changes Ohio's mandatory reporting laws. teachers, counselors, physicians, psychologists, social workers, nurses, and other mandated reporters will continue to be legally obligated to report suspected abuse or neglect. If a child is being abused, neglected, or exploited, or otherwise endangered, those reporting requirements remain fully intact. Likewise, this legislation does not limit authority of child protective services, law enforcement agencies, juvenile courts, or any other entity charged with protecting children from harm. Every safeguard currently available to protect abused or neglected children remains in place. I will now hand off this to my joint sponsor, Senator Serino, to finish.
Good morning, Chair Huffman, Vice Chair Johnson, Ranking Member Liston, and members of the Health Committee. Excuse me. This bill does not weaken child protection laws. This bill does not shield abusive parents. This bill does not interfere with investigations of abuse or neglect The rare cases involving abuse or neglect are already addressed through Ohio Child Protection System Senate Bill 274 simply ensures that absent evidence of abuse or neglect parents are not to be excluded from decisions involving their children's mental health care. Public policy should not be based on the assumption that parents are a threat to their children. The overwhelming majority of Ohio parents love their children, care about their children and want what is best for their children. Those parents should be treated as partners and not obstacles. Senate Bill 274 also reflects longstanding constitutional principles. The United States Supreme Court has repeatedly recognized that parents possess a fundamental liberty interest in directing the care, custody, and control of their children. Government should not substitute its judgment for that of a parent, except under extraordinary circumstances where the safety of a child is actually at risk. Those protections already exist under Ohio law and remain unchanged by this legislation. Some opponents may argue that parental involvement could discourage some children from seeking assistance. While those concerns deserve consideration, we must also consider the consequences of excluding parents from the treatment process. Mental health treatment is rarely successful in isolation. Long-term success often depends on family support, continuity of care, accountability, and engagement outside the counselor's office. Excluding parents from the process can undermine these goals and create barriers to effective treatment. When a child is struggling with depression, anxiety, self-harm, substance abuse, or suicidal thoughts, the answer should not be to sideline the people who know and care for the child the most. The answer should be to equip parents with the information necessary to help their child succeed. Ultimately, Senate Bill 274 is about transparency, accountability, and trust. Parents should not learn months later that significant mental health services were provided to their child without their knowledge. Parents should not be treated as spectators in decisions involving their own children. Parents should be recognized for what they are, the primary caregivers and decision-makers responsible for their children's futures. This bill does not force Ohio to choose between parental rights and child safety. We can and should protect both. Senate Bill 274 preserves every existing protection for abused and neglected children, maintains all mandatory reporting requirements, and preserves the authority of Child Protective Services and law enforcement to intervene whenever a child's safety is threatened. At the same time, it restores the role of responsible parents as active participants in decisions affecting their children's mental health and well-being. The Parents' Bill of Rights established the General Assembly's intent. Senate Bill 274 ensures that Ohio law consistently reflects that intent. Thank you, Chair Huffman, Vice Chair Johnson, Ranking Member Liston, and members of the committee. Senator Brenner and I would be happy to answer any questions.
Any questions from the committee? Senator Liston.
Thank you, Chairman. Thank you, gentlemen. I just want to make sure that I'm hearing this right because I a little confused based on what the law is and what you saying Right now in law mental health services can be provided for up to 30 days with the idea that these are the times when there's a child in crisis. A child in crisis goes to a counselor or a school sends them to the emergency department and they need immediate treatment. And so the law allows currently a brief period of time for them to receive treatment while perhaps they're looking for the family or while the child is in an acute crisis. And what I'm hearing is that that period of time, that 30 days, or six times, that's what your bill is specifically removing. Is that correct?
Correct. we're basically saying that the parents should be informed immediately. We're not saying that the child shouldn't go for those crisis services, but we're saying that the parents should be informed immediately. Also, the point of our testimony is that, look, if a child is being abused, the mandatory reporter should automatically kick in and inform, you know, law enforcement and appropriate agencies of what is going on if, in fact, they suspect that the parents are the one doing the abuse.
Sure, but those situations, the child's at school, they send them to the emergency room, parents at work, they work night shifts. We have a child in an emergency setting for 24 hours or however many hours in normal care, or a foster child where the guardianship is actually in a county services, and they've run away from their care and need emergency help. These are sittings that I certainly see and would be concerned in delay of care if there's not this sort of buffer zone. So in those circumstances, you envision that they just have to kind of wait at the hospital but can't be treated unless they get specific consent from parents that may or may not be reachable or guardians that may or may not be identifiable.
Through the chair to Senator Liston, no, emergency care, critical care is not to be delayed. It's to be coincident with parental notification as best as possible. So we don't see any situation where critical care required for the child would be withheld. it's just that parents need to be notified in the event that there is critical care required.
Through the chair, I'm not seeing that in the bill, so if that's the intent, maybe we would work on ways to ensure that that care is not withheld. Thank you, Mr. Chair.
Thank you, young men, for your bill today. I just have a question regarding to what are we considering mental health services? I heard you mention counselor. What are we considering mental health services here?
Through the chair to Senator Ingram, any kind of services that deal with mental health, whether it's a counselor, guidance counselor, whether it's a mental health professional, you name it, any kind of those services. All we're saying is we want the parent to be informed. Obviously, if there's a situation where the child is suspected of being abused, there is still the mandatory reporting and everything else that goes on there to protect the child, because we don't want that But in every other case, we would like to make sure that the parents are informed of what's going on.
Thank you, Mr. Chair. So my concern is that, here again, just like in House Bill 8, the intent was that if the teacher says, go see the counselor, at that point, because remember, if you're considering mental health services as a counselor simply talking to that student, that you would have to call the parent before they even went to the counselor. Is that what we're looking for here or what? Because regardless of what they are going for, the notion is that if that's considered a service, then...
Through the chair to the senator and members of the committee, if a kid is having a mental breakdown or something to that effect, obviously you need to deal with the child at the time in the classroom. We're just saying that they need to inform the parent that something is going on with their child, whatever that happens to be. If it turns out there's bullying, if it turns out that there's some other issues going on, we just want to make sure that the parents are informed so that they're also able to help address the child's needs.
Thank you. So I think that actually what we want to happen is you said simultaneously that if the student goes to the counselor, I'm hoping that doesn't mean the counselor can't counsel them until the parent is notified. Or if they do counsel them, then the parent is called and says, hey, Johnny was in the office today. I think we need to do further service, et cetera.
To the chair, to the senator, I think what will come out probably in some subsequent testimony is that, you know, and these are all hypothetical, of course, but, you know, if a student comes and asks to see a counselor, that does not trigger something that would require parental notification.
Okay.
Because what would the counselor call the parent and tell them? Your son asked to see me? If there's, once there's, in my view, an identification that there is a problem that is serious enough that the counselor believes that some remediation is necessary or some kind of, not treatment per se, but some kind of counseling that they're concerned about the welfare of the child, that they should notify the parents that that is happening.
I just want to make sure that, and I think we're probably on the same page, but I want to make sure that it doesn't make the student fear going to the counselor because then the parent gets called before they even get there. Like you said, what would the counselor tell the parent? So if mental health services are considered that counselor talking to that child, I just want to make sure that they're not notified. They don't have to be notified before.
Right. To the chair, to the senator, I think one of the things that we're talking about in the bill that Senator Brenner and I both mentioned is that the presumption should be that the parents are not going to be putting the child in danger, right, okay, as opposed to the opposite of that. And so if there are remedies available if the school or the child believes that by notifying a parent that they are putting themselves in some serious jeopardy of retribution by the parent that sort of thing there are remedies available in reporting that is available to protect the child We certainly agree with that
I just want to make sure that the child is not afraid to even say something to the teacher or to the counselor because this has to be told to them, especially we're talking like right now, it's not law if they're under 14, 14 and under. It's over 14, so that 16-year-old is not afraid to go to the counselor. And they have to be notified that if you go to the counselor, your parents will be informed, because you're counting that as mental health, and I don't want that to happen.
Right. Okay.
Thank you, Chairman.
I guess we're talking about informing parents, but the bill is not saying that. And the bill says parental consent, right? So calling them and saying, hey, we saw a counselor, doesn't meet the criteria that's being proposed in this legislation. The parent could say, first of all, consent implies that it would be beforehand. And secondly, if a parent says, I don't want you speaking to that counselor, I think there's a challenge here, right? There's a child in crisis, the school sends them to a counselor, the counselor can't speak with them based on saying they need consent. They have to call, identify the parent, get specific consent, which both has a timing issue as well as a potential conflict because we don't know at that time of crisis if parents are going to be in a position to consent. I'm just concerned about the intent of what you're saying, which is parents notified, great. But the language of the bill doesn't seem to match that, and I hope that that's something that could be addressed. Are you tending to say parental consent before they can talk to a school counselor at all? That's not what I'm hearing from your answers.
Through the Chair, if we need to make any modifications or clarifications, I think we're willing to do that. However, again, right now the current law is, I think, six sessions or 30 days. We're trying to say, wait a minute, that's way too long of a period to not let the parents know what's going on with their child. So again, if there's a crisis situation in a classroom, I'm sure the counselor is going to sit down. We're not saying that they need to be immediately informed. We're saying that there does need to be some form of letting the parent know what's going on if we need to make some minor clarification in that. I think I'm not speaking necessarily for my joint sponsor, but I think I'd be willing to work with the chair and the committee on that.
All right. Thank you.
Seeing no more questions, that will end the first hearing on Senate Bill 384. Oh, no, 274. Next up is the first hearing on the sponsor testimony. 384, Senator Lisson, regarding direct care staffing hour requirements for nursing homes. All right. Chair Huffman, Vice Chair Johnson, members of the Senate Health Committee, thank you for allowing me to provide sponsor's testimony
on Senate bill 384 a bill to make sure older Ohioans receive needed direct patient care while residing in a nursing facility We all know Ohio population is aging and it important that older people in our state can age with dignity and support There are nearly 950 nursing facilities in Ohio caring for tens of thousands of residents each year, many of whom require extensive assistance with activities of daily living, medication administration, mobility, nutrition, hydration, dementia-related behaviors, and ongoing monitoring for changes in conditions. Current Ohio law requires nursing homes to provide a minimum daily average of 2.5 hours of direct care per resident. However, Ohio law permits facilities to count hours worked by registered nurses and licensed practical nurses performing administrative and supervisory duties towards that requirement. This means time budgeting, billing, doing compliance work, or even doing building maintenance could be counted. As a result, a staffing level reported as meeting Ohio's direct care standard may not accurately reflect the amount of hands-on care available to residents. I've heard from many constituents about concerns that their loved ones were not getting the care they needed, as the scheduled staff time included administrators on site who were not available to help with hands-on care. As you can imagine, a single fall can result in an injury from which people never recover. SB 384 is simple. It changes the law so only time directly taking care of people count towards this requirement, not hours doing administrative tasks. The 2001 CMS sponsored staffing study, which is the landmark study, found that higher levels of direct nursing care were associated with improved resident outcomes, and they identified the staffing thresholds of approximately 4.1 nursing hours per resident per day as being associated with stronger quality performance. Importantly, this benchmark reflected direct nursing care available to residents rather than the combination of bedside care and administrative activities. Subsequent research has continued to demonstrate relationships between direct care staffing levels and lower levels of falls, pressure injuries, avoidable hospitalizations, weight loss, dehydration, and declines in ADLs. Federal policymakers reached similar conclusions when CMS developed its 2024 nursing home staffing rule requiring 3.48 hours per resident of hands-on care. Although these numerical requirements are not in effect, the CMS-based rule on direct care hours rather than overall nursing payroll was because resident outcomes depend on this care actually available to residents. Ohio law only requires 2.5 hours. This includes administrative and nursing care and remains below the approximately 4.1 hours identified by the staffing study that shows best practices. Ohio has historically lagged behind national and regional staffing benchmarks. Scripps, the most recent Scripps analysis found Ohio had a median total staffing levels of approximately 3.8 hours per resident day compared with national median of 4.08. Neighboring states reported higher staffing levels, including Michigan at 4.35, Kentucky at 4.13, Pennsylvania at 4.12. And at the same time Ohio has had increasing numbers of nursing home complaints and quality concerns The 2024 Scripps study Ohio nursing homes reported that of those that then 3 total nursing hours per resident 0.31 hours of that was administrative and supervisory functions, not direct patient care. So roughly eight or 9% of the reported hours were not available. While these hours on average do remain well above our legal requirements, there was wide variability from facility to facility. So those that only meet the minimum standards may be as much as 20% below the legal requirement in terms of actual patient care. So lots of numbers. This legislation doesn't seek to increase the minimum staffing requirement, but it does seek to ensure that the existing staffing requirement measures the important component that does impact outcomes, which is the direct care time. Administrative functions, budgeting, scheduling, personnel management, reporting, quality assurance, education, supervision, these are all important and necessary, but they serve a different purpose than direct resident care and should be measured separately. Again, the majority of excellent facilities that provide care above and beyond minimum requirements would not be impacted by this bill. However, the bill will better prevent bad actors from staffing at the legal minimum and using this loophole to provide substandard care. Ohioans deserve better. By prohibiting administrative and supervisory hours from being counted towards Ohio's daily average staffing requirement, requirement, we can improve transparency, strengthen accountability, and align Ohio's staffing methodology with the decades of research and federal policy principles to ensure that our state's staffing standard more accurately reflects the care that Ohio residents need every day. With that, I will happily answer questions and hope that you will support this change.
Any questions from the committee?
Yes. Thank you, Mr. Chair. I just have one in regard to were they using that administrative time in order to continue to be paid for doing that work while they were not doing the direct service?
Through the chair, to the senator, I'm sorry, can you clarify what you're asking?
Were they being the nursing facilities? Say, for instance, if I go to see someone, I'm not in a nursing home, but I've got administrative work to do, and I'm counting that as part of the time that I'm actually doing the direct service. Does that make a difference in the pay that that person receives, because they're usually paid for the visits and the hours, et cetera?
Through the chair to the senator, I do not believe so. I think the roles are actually different, but sometimes the staffing titles even would be different, which I suspect means different pay. But I hope with future testimony we can hear from individuals that can give more detail on what they've experienced and what the actual practice looks like in nursing facilities.
Good. Thanks.
Anything? Senator Rubenstein?
Thank you, Mr. Chairman. So I understand the feds are saying they would like to see 4.1 hours of direct care we're at 2.5. Is that It says proposed regulation, so that is not official yet?
Yeah, through the chair to the center. There's actually a couple of different nuances. One, when they've studied this, right, like there's a benchmark study in 2001, and they said that what appears to be optimal is that 4.1. CMS proposed a rule in 2024 that said, okay, 4.1 may be optimal. We recognize there's going to be variability. And so they proposed 2 point, I'm sorry, 3.48 as the requirement of only direct patient care. They didn't include administrative time. Now that rule is not in place. So there's some, a court vacation of that rule's implementation between the 2024 and 2025 administrations. As you know, things sort of changed in the landscape. But I think the concepts remain the same. The best evidence we have is 4.1. When they were looking to do it nationally, they were saying, hey, there's going to be variability, but it should be direct patient care. And maybe 4.1 is hard to apply everywhere, so they went a little lower. Ohio is lower still at 2.5, but we in that 2.5 don't require it to be just direct patient care. And so, again, I've had some constituents talk to me about their experiences and even talking in multiple nursing facilities. They have found, hey, the administrator who's in the office is being counted towards the number of hours that their family member is getting for nursing time. And I think we've looked broadly. I don't think this is a widespread practice, or I hope it's not, not per what Scripps Gerontology shows. but I think they're seeing a wide variety, and so the goal is to say in this group and potentially the lowest quality, and I don't know the quality metrics they have, but in the group that may be taking advantage of this in a way that we don't intend, this change in law could improve those institutions, right?
Does that make sense? Yeah, follow-up, please. So is it correct to assume if the feds adopt the 3.48 and the courts are silent on that,
it will be incumbent on the state to also do 3.48, otherwise we would lose funding potentially? Yes, we would be required to do 3.48 for Medicare, yes, for federal funding.
Yeah.
Seeing no further questions, thank you very much. That will end the first hearing on Senate Bill 388. Oh, no, 384. Next up, the first hearing on Senate Bill 388, Senator Weinstein, the designate Augmentive and Alternative Communications Month. Whenever you're ready.
Thank you, Chair Huffman. Vice Chair Johnson, Ranking Member Liston, and members of the Senate Health Committee, thank you again for the opportunity to provide sponsor testimony on Senate Bill 388. Senate Bill 388 designates October as Augmentative and Alternative Communication, or AAC, Awareness Month in Ohio. This legislation is a companion bill to House Bill 766 by Representatives Salvo and Lorenz, which recently received its third hearing in the House. It also aligns Ohio with the International Society for Augmentative and Alternative Communications AAC Awareness Month an effort first established in 2007 and now recognized in dozens of countries around the world Although most Ohioans may not be familiar with the term AAC these tools play an essential role in the lives of thousands of children and adults with communication disabilities. AAC is used by individuals with autism, cerebral palsy, Down syndrome, children's childhood of speech, traumatic brain injuries, and many other conditions that affect a person's ability to communicate through speech. These tools can take many forms, including speech-generating devices, communication boards, eye gaze systems, text-to-speech applications, and other assistive technologies that help individuals express themselves and interact with the world around them. While there remains a need for more comprehensive data, current estimates suggest that more than 76,000 children in Ohio could benefit from AAC or need AAC to communicate effectively. The idea for this legislation was brought to me by a constituent of mine, Jordan Zimmerman. Jordan is a non-speaking autistic woman who wasn't introduced to AAC technology until she was 18 years old. Prior to receiving AAC, it had been suggested that Jordan had an IQ of approximately 60, and she didn't have educational opportunities that reflected her true abilities or potential. After gaining access to an AAC tool and proper support, Jordan graduated from college, earned advanced degrees, became an educator and advocate, and now speaks nationally and internationally about communication access and disability inclusion. For many Ohioans, communication happens so naturally that we rarely stop to think about the tools that make it possible. But for individuals with significant communication disabilities, effective communication often depends on access to AAC tools and the support needed to use them successfully. When those supports are available, individuals are better able to participate in school, pursue employment, build relationships, and engage in their communities. Yet many Ohioans remain unaware of AAC and the life-changing role it can play. As a result, too many Ohioans and their families continue to face misunderstandings, delayed access to support and barriers that otherwise could be addressed. This lack of awareness is what this bill is intended to address. By recognizing October as AAC Awareness Month, Ohio can help elevate understanding of these tools and highlight the individuals, families, educators, therapists, and caregivers who rely on and support the AAC community every day. It's also an opportunity to ensure these conversations continue beyond a single month and lead to a stronger understanding and better support over time. Thank you again for the opportunity to provide sponsor testimony to Senate Bill 388. I would be happy to address any questions you may have.
Any questions for the witness?
Yes. Thank you, Mr. Chair. Thank you for this. I've seen children with special needs who are nonverbal but can speak through their machines, and they're delighted because then they get to say what they want to say. So that's a fabulous thing. What is the expectation, though, during that month and with the state making an awareness month? Are we asking folks, because your person didn't get a device until she was 18, the child that I'm talking about was in elementary school, so are we doing more, are we going to try to force or do more from the state level through the health board or disabilities?
I not sure THROUGH THE CHAIR THANK YOU SENATOR FOR THAT QUESTION I ACTUALLY HAVE ANOTHER bill on AAC that working or that I just testified for before the Finance Committee to expand insurance coverage for AAC devices to children under the age of 18 Because while federally regulated programs, excuse me, federally regulated insurance programs have or policies have coverage, state regulated do not. So I'm also working in addition to elevating awareness about this so people understand that there are these tools. And for many kids, they will be able to access these tools either through their insurance or if they're in a situation where their parents can afford. That's step one. Step two is, you know, I am trying to expand insurance through a separate bill as well. But this one, I'm really excited about the bipartisan support we've got in both chambers and the movement that we're seeing on it. So it's sort of a two-step process, awareness and then hopefully access.
Seeing no further questions, that will end the first hearing on Senate Bill 88. Next up is – Mr. Chair. Yes. Next up, third hearing, all testimony on Senate Bill 423 regarding employment status of health care workers for certain laws. There is no testimony. That will end our third hearing on Senate Bill 423. Next up, the second hearing on Senate Bill 347, an Act, she wins act. First up, Cindy Roy. Whenever you're ready.
Good morning, Senators, Chair. My name is Cynthia Roy, and I'm a licensed professional clinical counselor, supervisory status and good standing here in Ohio. For over 20 years, I've had the privilege to meet with clients, bringing a wide variety of concerns. A large portion of the clients come for support around their decisions to have abortions. I have met women ages 14 to 80 who have had from one to eight abortions. I have also met with husbands and boyfriends who have huge regrets because they did not understand the negative impact abortion would have on their wives and girlfriends who they pressed to get abortions. I have also assisted siblings and friends and mothers who encourage their sisters, daughters, and besties to get abortions. Overwhelmingly, the post-abortive women have expressed anger, anxiety, and differing levels of trauma that have impacted them to this day. The anger is directed toward the abortionists and the law for not telling them the whole truth. One client cried, they lied to me. These statements speak to the necessity for full disclosure around the surgical procedures of abortion and the full disclosure around chemical abortion. The trauma is often exhibited in these women by sleep dysregulation, nightmares, night terrors, insomnia, physical ailments, discomfort to irreversible and disabling pain, reduced executive functioning, inability to trust decision-making, dysregulated eating, cannot tolerate meat, bones, or liquids, sensory issues, sounds similar to machinery or the feel of the bathroom for a chemical abortion or smells familiar to the surgery or the toilet during the chemical flushing Relational dysfunction frozen and unable to risk it happening again Promiscuity, sex addiction to gain control over how it happened and either not conceive or conceive and carry to term.
And grief, crying jegs, depression, anxiety, lack of resolution, rumination, going over and over how did it happen and why didn't she know. These are a few of the examples of the vast impact to girls and women that I have witnessed. So here's what happens when there's no time between the crisis being someone being made aware. Our brain in crisis overrides the executive functioning. That's our prefrontal cortex. Our brains fire more quickly to the amygdala, the base of the brain, to move us toward fight, flight, freeze, and faint, an emotionally-based response. Without time for the brain and emotions to settle, a woman moves to abort without an educated, thoughtful, and aware program of the possible longevity of the impact. Can I stop for a second? So I made a mistake. We're going to limit all witnesses to three minutes today, and we will all do the same when we have opponent testimonies. And Senator Liston will make sure I stick to my words on both sides. And so we're going to start the clock because looking at your testimony, it looks like it's going to take over 20 minutes. But everybody today and in further testimony will get three minutes. And I apologize. I did not say that in advance. So the clerk will start the clock. And, Your Honor, Chairman, I am wrapping up. Okay. No, that's fine. I was on three to five minutes. I made a mistake, and we'll try to rectify it. I'm on three to five minutes today. Absolutely. So I am here in support of She Wins. I am here to give a voice to the girls and women who wish they had been told, told more details, and given a little more time to consider the possible devastation to their physical health, emotional health, mental health, and relational health. It is time to take the time to do informed consent well. Thank you. And now, questions? Any questions for the witness? Seeing none, thank you very much for your time today. Thank you. Next up, Dr. Priscilla Coleman.
Thank you, Chair Huffman, Vice Chair Johnson, and members of the Health Committee. Appreciate the opportunity to address you today. I had planned six minutes, so I'm going to just skim the best of my ability. I also have a long written document that was submitted to the House, and I believe you have that. So I'm here to explain why Ohio's proposed legislation, Share the Health and Empower with Informed Notices, the She Wins legislation, particularly the 24-hour reflection period, is scientifically justified, patient-centered, and essential to protect women's personal autonomy, as well as their emotional and psychological health. My opinions are based on my education, research, and professional experiences pertaining to abortion decision-making and mental health outcomes. I have a Ph.D. in Lifespan Developmental Psychology. I'm a retired full professor from Bowling Green State University with over 60%. 60 peer-reviewed articles. I've served as an expert witness for two decades. Further, I've been invited to speak domestically and internationally before legislators, medical professionals, and government officials considering abortion policy. I believe the She Wins legislation is crucial for protecting mental health of Ohio citizens. I address the complexity of abortion decision-making and the essential role of substantive, personalized, informed consent, as well as the psychological risks, which research shows exceeds those associated with childbirth. Studies indicate many women seeking abortion experience ambivalence, decisional distress, and pressure or active coercion from others. A 24-hour reflection period supports sound decision-making by allowing time to consider options, seek support, and avoid falling victim to the coercive behavior of partners, parents, and others. Decisions made after receiving complete information, opportunities to ask questions, and adequate reflection time are more likely to align with a woman's values, enhance clarity, reduce regret, support autonomy, and maximize positive mental health outcomes. Substantial percentages of women report viewing abortion as morally wrong or inconsistent with their beliefs, even when they proceed with the termination. This conflict between values and behavior can lead to guilt, emotional distress, grief, and severe mental health problems. Abortion decisions are well established as highly stressful for most women. When stakes are high and outcomes uncertain, stress can impair judgment, narrow thinking, and lead to rushed decisions. Under duress, individuals rely more on intuition and are less likely to engage in logical, careful, strategic reasoning, in addition to being more vulnerable to influences of others. Studies show that...
That's three minutes if you can try to wrap it up.
That's it? I'm at three.
No, you can wrap it up. I'm not going to cut you right off.
Just summarize. Okay, well, the literature that addresses abortion and mental health is upwards of 500 studies internationally. The strongest studies have come out in recent years. An example of one of these studies was a longitudinal 17-year study with 1.2 million women in Canada published last year. You don't hear much about it in the press, but methodologically, it's the strongest study available worldwide. And it showed high rates of much higher rates of suicide, hospitalization for suicidal ideation, substance abuse and other mental health problems compared to live birth and compared to stillbirth. So there's an enormous literature out there that shows that mental health problems associated with abortion are not minimal and impact upwards of 30 to 40 percent of women when you consider all the possible outcomes. My position is women deserve the information, the best science out there, and they deserve to have reflection time so that they can review options and optimize their well-being.
Is there any questions for the witness? Seeing none, thank you very much. Next up. Thank you. Thank you. Dr. Alicia Thompson. There's 60. There's 60, yeah. Thank you Chairman Huffman Vice Chair Johnson Ranking Member Liston and members of the Ohio Senate Health Committee Thank you for the opportunity to provide proponent testimony
in support of the She Wins Act today. My name is Dr. Alicia Thompson, and as a board-certified OBGYN with more than 15 years of experience in military, academic, and community medicine, I support House Bill 347 because women considering abortion deserve a clear, honest information about the potential risks before making a permanent medical decision. In every other area of medicine, informed consent requires physicians to explain the known risks, benefits, alternatives, and indications of any procedure. Abortion should not be treated any differently. Women have the right to understand possible complications of this procedure, such as hemorrhage, infection, uterine or cervical injury, and incomplete abortion, which could require additional surgery. Women should also be informed that medication abortions carry unique risks, including severe bleeding, ongoing pregnancy, undiagnosed ectopic pregnancy, and retained tissue that may require emergency medical treatment or further surgical intervention. While some complications may be uncommon, their seriousness makes them highly relevant to a patient's decision-making process. House Bill 347 helps ensure that women receive this information in a way that they can clearly understand and have adequate time to consider. The bill recognizes that informed consent is not simply signing a form, but it's a meaningful medical conversation that allows a patient to ask questions, evaluate risks, and make a voluntary and informed decision. The legislation's 24-hour reflection period is also consistent with standards commonly used for other significant elective medical procedures. Giving women time to process information, consult trusted family members, and even other medical professionals, and to reflect on their options promotes patient autonomy and responsible medical care. Because the informed consent discussion can occur on the phone, in person, or even virtually, the bill allows flexibility while still prioritizing patient understanding and safety. Ultimately, women in Ohio deserve complete and accurate information about the possible harms associated with abortion procedures and abortion-inducing drugs. House Bill 347 strengthens informed consent protections and helps ensure that women can make fully informed decisions about their health and their future. I thank you for the opportunity to speak to you today, and I'm happy to answer any questions.
The witness. Yes.
Thank you, Mr. Chair. I just have one, and that's in regard to what information you know for a fact that all of the women are receiving when they go in for their abortion, because these are doctors who do the procedure and not just the clerk who has them sign the paper.
Through the chairman to the representative.
Thank you for the question. Agreed. I have full confidence in my colleagues that physicians across the state do their very best to support and give adequate care. But I don't think that standards such as regulatory or statutory standards that set up a safety framework is there because physicians don't perform their duty, but because patients are uniquely vulnerable and it's meant to be a well-informed safeguard that every patient should be entitled to.
Paul? Sure. Thank you, Mr. Chair. So therefore because all doctors ethically would give that information and make sure you aware of the procedure the possibilities that you may not recover if we do this and that or the other but are all doctors, unless it's malpractice, allowed to have a suit brought back on them even after a year or however long it takes. I don't know if there's a limitation in here or not. I have to look at the bill again to see if there's a limitation on how long the person could come back and sue the provider or that doctor who's done that procedure. Should we have that for all doctors in case something happens a year from now after I had foot surgery?
Through the chair to the representative, I hope I'm understanding your question.
So as far as I know, there is a statute of limitations regarding recognition of adverse outcomes of procedures, and that statute of limitations is typically, as far as I know, for two years. That would apply to OBGYNs or other specialties. However, I think the primary action of this regulation statute would be to ensure that women are given risks prior, given the information to help them make medical decisions before they ever enter into the procedure. So I think, in all humility, I try not to use the word all. I do think that OBGYNs and physicians in the state do a good job of providing informed consent, but I can sit with a patient for 45 minutes, think that I'm extraordinarily thorough and still receive messages in my in-basket a day or two later, just clarifying what they're getting themselves into. And I think that having a certain standard available to all patients who are very vulnerable is just good medicine and good legal care.
No, I'm good. I just want to take a look, because I think there are prohibitions for those specific providers that are not the same for other medical doctors.
Any other questions? Seeing none, thank you very much. Next up, Emily Hoagler, Americans United for Life. Good morning, Chairman Huffman and members of the committee.
Thank you for allowing me to speak today. My name is Emily Hoegler. I'm an attorney for Americans United for Life. I urge a favorable report on House Bill 347, the She Wins Act, for three reasons. First, Ohio has the power to mandate medical disclosures under federal law. In Dobbs, the U.S. Supreme Court held that states have a legitimate interest in regulating abortion to protect maternal health and safety and to preserve the integrity of the medical profession. Under this federal framework, state legislators hold the power to set a statutory baseline for informed consent. House Bill 347 uses this exact authority to ensure patients receive objective medical facts, legally protecting a woman's reproductive choice from clinical emissions. Second and alternatively, House Bill 347 satisfies the strict scrutiny standard under Article 1, Section 22 of the Ohio Constitution. The state constitution permits abortion regulations that use the least restrictive means to advance patient health. This bill is narrowly tailored to meet that requirement. The disclosure mandates apply exclusively to physicians performing elective non-emergency abortions. The 24 reflection period to review medical data outside of the clinical environment is the least restrictive mechanism to secure informed consent because it allows patients to review this information without any pressure or haste To ensure zero barriers to critical emergency care the statute explicitly exempts miscarriages ectopic pregnancies and immediate medical emergencies Third and finally, ensuring informed consent to abortion is a widely accepted, evidence-based standard of care. Informed consent is a foundational principle of modern medicine. Providing comprehensive information is necessary to receive true informed consent. To be fully informed, a patient must know the benefits, risks, and alternatives before abortion. In specifically the abortion context, informed consent protects against things like coercion. Research suggests that between 70 and 60 percent of women report feeling pressure to receive an abortion. Unwanted and coerced abortions are associated with a 43 percent higher risk of clinical depression and suicide ideation. and House Bill 347 strengthens the doctor-patient relationship, giving doctors time to screen for things like coercion and informed consent of the patient and provide her with information on her right to withhold or withdraw her consent. Also, in response to Senator Ingram's question to my colleague before, in terms of if women are actually provided or counseled adequately under the law as it is now, polling suggests that between 66 and 84 percent of women say that they don't feel that they were adequately informed of the nature of the abortion procedure as well as the alternatives, and 60 percent of women in polling who received abortion said that they probably would have kept the child if they received more material support and information about material support, which this bill does provide. Informed consent is a mandatory rule of modern medicine, and House Bill 347 does not obstruct reproductive access. It simply equips Ohio women with the identical standard of care of risk disclosure and freedom from duress required for any other surgery. I urge this committee to issue a favorable report on the She Wins Act, and I would be happy to take any questions.
Thank you. Any questions for the witness? Yes.
Thank you, Chairman. And so what I'm hearing is you think that this 24-hour period and a state-required consent form is the least restrictive way to ensure that there is informed consent in a medical procedure.
Correct. In terms of this procedure, yes.
This procedure, but not any other medical procedure. It would depend on the procedure.
So under Ohio statute, there's always a requirement for informed consent. In terms of time periods, it depends on the procedure. So, like, for example, federally, there's a 24-hour waiting period for sterilization procedures and things of higher gravity. And these types of procedures, I'm not a social scientist, but the data seems to indicate that this is a very important and severe, potentially could have severe health, mental and physical health consequences for women. And so providing them with information and the time to process that information, especially for an elected procedure, seems to be the least restrictive means.
So by that argument, in the least restrictive approach to inform consent on non-emergent procedures with impact, impact, I mean, might, in order to be consistent, we need to be looking at pretty much at all elective procedures that have an impact. I'm not, you know, like, we're not here talking about even a hysterectomy as a procedure that might have an emotional impact. You know, surgery, testicular removal, cancer, these are things that might have an emotional impact, but this is not what this, you know, you're saying that this is the least restrictive standard, but it's only for this one procedure. So I'm not following the legal argument that this particular procedure is different than any other statutorily required informed consent the way it's typically done. So the examples that you just provided under federal law, which would apply, so there's not
like an additional Ohio statute. But under federal law, those sort of sterilization procedures do require a 24-hour informed consent waiting period. And for procedures like abortion, and the Supreme Court held this in Casey, and although Casey was overturned, this reasoning still applies because it's just applying a type of statute to the idea that there's a constitutional right to abortion, as there is under Ohio. But there in Casey, the Supreme Court held that because of the nature of the abortion procedure, a 24-hour waiting period, and an informed consent requirement was the least restrictive means. Essentially, it did not unreasonably inhibit the individual's federal right to abortion.
So through the chair of the witness, so then I guess I'm stuck on, yes, we require informed consent, and we're picking out this one thing in the state rather than the thousands of other procedures that lead to changes in people's lives and saying, well, this is the least restrictive thing we can do when we don't do this for the thousands of other procedures that change people's lives that they undergo.
It seems way more restrictive. So legally there are other types of operations and procedures that do require 24-hour waiting periods, and I think the law tends to put waiting periods in effect when someone is going to make a life-changing decision, like a sterilization procedure, an abortion procedure. There's even statutory waiting periods for marriage and divorce and things like that. So the intention is not to restrict an individual's right to exercise whatever right we're talking about, in this case abortion, but it is to protect the individual, to make sure that they're provided with the counseling and the information and then the time to process that information to make a life-changing decision. And also to be clear in this situation, all the statute is doing is providing the woman with a cause of action to enforce that standard of medical care So we saying a woman if she doesn feel that she was adequately informed can look at this statute and say yeah I wasn given enough time and I wasn't given enough information, and I was harmed by that, and I deserve reprieve for that. Much in the way that anyone who is not provided with information currently has the ability to.
Correct, but again, in the abortion context, we see very high rates. I think the number was between 66 and 84 in one study,
which I also provided written testimony that has the citations, if you'd like to look into that, but a high percentage of women, when we're talking about abortion counseling report, that they don't feel that they were adequately counseled. And that kind of makes sense with the nature of abortion procedures. I could see there being sort of reticence on the part of doctors to say too much or to do something that might be perceived as an interference with their right to abortion. So maybe they'd be a little bit more reticent to provide information. I don't exactly know the reasons. I just know that that's what women report, that they weren't adequately informed. So we just want to make sure that they have a cause of action to enforce their right to receive a certain standard of medical care.
Sure.
Any other questions? Okay.
And I guess maybe I'm concerned with the language of the bill and what is required as to what has to be told to the person. And then the medical board, I believe, comes up with the final ruling. The Department of Health, though, comes up with the final ruling as to some of the language. So since this will also apply to pills by mail, then this requirement for a physician would also be the person who is making that. How are we going to do that? Tell me.
I'm not exactly sure I understand your question.
Nobody understands my question. No, I'm so sorry.
That's okay. The question is whether or not we're putting this very strict requirement that's here in the bill itself, that we're requiring that of the physician 24 hours before the procedure, and of course the difficulty is that 24 hours before the procedure, procedure if you can't schedule a doctor within a few weeks then that makes a real difference as to whether or not you can continue to have an abortion depending on how far along you are when you decide to call or that you even find out that you pregnant I mean you already may be six weeks when you realize that you are pregnant I known people who had babies that didn even know that they were pregnant at all So it does happen.
But we're requiring inform her of any medical assistance benefits that may be available for prenatal care, etc., etc., the options as to whether or not to have the baby and parent it themselves or to give it up for adoption, the medical risks associated with caring full term, and that would be difficult at that time because it would depend on the patient. If it's not your OBGYN who's been seeing you or know you, then it would be difficult. but the nature or the purpose of a particular abortion procedure to be used. And this can be very, very technical. And the difficulty, especially after the sponsor of the bill said last week, did we hear this last week? I don't know. Said last week that some of those people aren't smart enough to understand about abortion, period. how would they determine some of that information that they're going to be receiving anyway? So I'm just concerned with we're saying one thing, and of course this has nothing to do with the amendment that the people voted for. At least that's what I was told. And then we're turning around and making it very, very difficult for someone to get all of this information within a certain period of time. And even though it sounds good, we'll wait 24 hours. and you have to see the doctor, that all depends on when you can see the doctor and how far along that that person is. So it helped me with how we plan to do this, not just physically here, if someone goes to Planned Parenthood or something, how that's going to happen if somebody's placing an order online.
So in terms of mail-order abortion, I believe that's why the authors of the statute included the ability for there to be virtual or telecommunication informed consent where there isn't that in-person requirement, which again is ideal to screen for things like coercion and abuse but in those exceptional circumstances And I understand your point Senator about there being a difference depending on how far along you are but I think that another reason that legislation like this is necessary So, for example, a lot of women might not know that the risk of maternal mortality from abortion increases exponentially by 38% each week after eight weeks of gestation. So the gestational age of the child dictates the risk of the life of the mother when she's undergoing this abortion. So it is very important that we're able to determine where she's at in terms of her gestational age of her pregnancy to properly inform her of the risk she's undergoing when she's obtaining an abortion procedure. And also this bill is... The intent of this is to empower women, not to restrict their access to abortion. Again, if the statistics... And I cited my exact sources. I don't recall the names of them right now, but the statistics indicate that the majority of women do not feel that they were properly informed before their abortion of the risks and nature of the procedure, and particularly of alternatives, which is why these types of things are required. And then in terms of, I believe you asked about sort of being able to explain, or women potentially not being able to comprehend the medical risks.
No, I didn't say that. Oh, okay. The sponsor said that last week.
Okay, okay. I was going to say, because I think doctors are typically able to sort of say things in a way that we can understand them. But even just the risk that I just stated, right, the risk of maternal mortality increases exponentially each week after eight weeks of gestation. Women need to know that, and I think should be able to know what risk they're going to undergo when they receive an abortion, whether it be mail order or in person.
Thanks.
Any other questions? Thank you very much. Thank you. Next up is Stephanie Thompson. I have a lot of these happening here today. I will make note of your testimony from Katie Delanne, Ohio Right to Life, Marsha Forsen, Catholic Conference of Ohio, Brian Fultz, Center for Christian Values, Dr. Monica Cherie Wobblehorst, M.D., Nixis Bunch, J.D., and Brian Hurley, J.D. Is there anything else before the committee today? Well, let me say this, that will end the second hearing of House Bill 347. Seeing no other business, this committee will be adjourned.