Report of John G. Gianopoulos.

Re: Karlin et al. v. Foust et al. August 6, 1996 1. I am an Associate Professor of Obstetrics and Gynecology at Loyola University Medical Center and currently serve as the Acting Chairman for the Department of Obstetrics and Gynecology. I have served as the Residency Program Director, the Director of Graduate and Undergraduate Medical Student Education for reproductive biology for Loyola University's Stritch School of Medicine. I am well versed in the standards of practice of obstetrics and gynecology as well as educating young physicians into those standards. As part of my teaching responsibility, I educate residents as to the nature and efficacy of obtaining informed consent prior to the performance of surgical procedures. I have reviewed the materials concerning Wisconsin AB 441 for the performance of elective termination of pregnancy. 2. Informed consent requires that the patient be made fully aware of the operative procedure which he or she is about to undertake. Informed consent requires that certain elements be met to be valid. A. Medical necessity and/or condition requiring the potential operative procedure. B. A complete description of the nature of the procedure. C. A complete description of any potential short term complications such as pain, discomfort, or immediate potential problems such as bleeding. D. An explanation of any potential long term complications of a procedure such as infection, organ disruption, or disability. E. A thorough explanation of alternatives to the proposed surgical intervention as well as potential outcomes whether alternative therapies are chosen. F. A full explanation of potential follow up after the procedure is completed. G. The answering of any questions or concerns which the patient or the patient's family may raise regarding the procedure, and an assessment of the patient's comprehension of the information given. 3. AB 441, in my opinion, attempts to mandate that the above definitions of informed consent be applied to the procedure of voluntary interruption of pregnancy. A decision to undergo an elective termination of a pregnancy is both difficult and arduous. The patient must be fully informed of the potential risks to herself, both short and long term. She must be fully informed as to the nature of the procedure and if there are potential options for adoption, foster care, or care for a child if she were to choose to change her decision to terminate the pregnancy. The statute allows for a reasonable amount of time for a patient to reflect on the mandated information given to her regarding these aspects of the procedure. 4. It is standard medical practice for the physician who performs a medical/surgical procedure to consult with the patient and examine the patient prior to the performance of that procedure. AB 441 mandates that the physician who will perform the procedure, or a reasonable, competent alternative physician, obtain the informed consent and explain to the patient the risks, complications and alternatives. As stated in the statute, women who seek elective abortions in many Wisconsin facilities normally do not have a prior patient-physician relationship with the physician who is to perform the procedure. This is extremely unusual in any other medical condition. The statute mandates an acceptable standard of care for a physician to meet, examine, and explain an operative procedure to the patient prior to the performance of that procedure with ample time for the patient to assimilate the information given and respond with appropriate questions. The statute, by mandating a physician face to face contact with the patient prior to the procedure, conforms to the standard of routine medical practice prior to any patient's surgical procedure. 5. The statute, in my opinion, also protects women seeking elective termination of pregnancy from any potential conflict of interest between the provider of the procedure and her wish to have this procedure performed. …