Senate bill would repeal
isle Pap smear law

Sen. Rosalyn Baker says
that all of the women in the
Senate are supporting the bill

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By Helen Altonn
haltonn@starbulletin.com

A 29-year-old Hawaii law requiring hospitals to offer Pap smears to all hospitalized women age 20 or older would be repealed under a controversial bill moving through the Legislature.

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Bill proponents, including the state Health Department and Healthcare Association of Hawaii, which represents hospitals, say the law is outdated, impractical and no longer necessary because physicians now screen for cervical cancer as part of a normal gynecological examination covered by most insurance plans.

Opponents, including health care attorney Thomas Grande, Planned Parenthood of Hawaii and the Hawaii State Commission on the Status of Women, argue that repealing the law would affect poor women who do not regularly see doctors.

Grande said the law was passed to make sure every woman admitted to a health care facility is offered Pap smear screening (unless an attending physician says otherwise or it has been performed within a year).

He said hospitals "are trying to justify after the fact that they've failed to comply with the law since about 1980."

Sen. Rosalyn Baker (D, Honokohau-Makena), Senate Health Committee chairwoman and 26-year cervical cancer survivor, introduced the legislation to repeal the law.

She said all women in the Senate support the bill, Senate Bill 1241, House Draft 1.

"Absolutely nobody testified against it on the Senate side," she said, adding that Grande has not talked to her about his concerns.

Baker said it is her understanding after looking into the issue that the law is "an obsolete practice and statute," enacted before Pap smears were readily available on an outpatient basis and covered by health plans.

Baker said she is part of the American Cancer Society leadership on Maui, and the society has not said repeal of the 1974 law is a problem.

Former state Health Director Bruce Anderson and his successor, Dr. Chiyome Fukino, both said the law is not necessary or practical.

Rich Meiers, Healthcare Association president and chief executive officer, said Anderson discussed the issues last July with the department's Office of Health Care Assurance and Breast and Cervical Cancer Detection Program.

They agreed cervical cancer screening is best done on an outpatient basis by a specialist in obstetrics and gynecology, so Anderson directed the staff not to enforce the law and to work with the association and others to draft a bill to repeal it, Meiers said.

Former legislator Annelle Amaral, testifying for Planned Parenthood of Hawaii at a House Health Committee hearing, pointed out that cervical cancer remains disproportionately high for Asian and Hawaiian women, and "Hawaiian women die of it because they do not get treatment in time."

Rather than repeal the law, she suggested an amendment mandating community health care centers to "offer uterine cytologic examinations to all female outpatients 20 years or older," she said.

Hospitals testified that it is disruptive, difficult and costly to perform gynecological tests on patients, especially when they are there because they are ill.

The bill's supporters also said state-funded treatment services for breast and cervical cancer are available for women who do not qualify for coverage under other programs.

"It's not a matter of what other resources are out there," Grande said.

"It's a matter of are we going to hold hospitals to the same standard we hold for every other member of our community (to follow the law)."

The American Cancer Society estimates about 12,200 new cases of cervical cancer will be diagnosed for the United States this year, including about 50 in Hawaii.