NY State Senate Bill 2023-S5517A

Senate Bill S5517A

2023-2024 Legislative Session

Requires the advisory council on maternal mortality and morbidity to undertake a review of the cesarean births at hospitals in the state

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Current Bill Status - In Senate Committee Rules Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jun 07, 2024	committed to rules
Mar 12, 2024	advanced to third reading
Mar 11, 2024	2nd report cal.
Mar 06, 2024	1st report cal.605
Jan 03, 2024	referred to women's issues
Apr 19, 2023	print number 5517a
Apr 19, 2023	amend (t) and recommit to women's issues
Mar 07, 2023	referred to women's issues

Votes

- Mar 6, 2024 - Women's Issues Committee Vote
  S5517A
  
  6
  
  Aye
  
  0
  
  Nay
  
  1
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Women's Issues Committee Vote: Mar 6, 2024
      
      aye (6)
      
      Persaud
      
      Salazar
      
      Scarcella-Spanton
      
      Serrano
      
      Webb
      
      Weik
      
      aye wr (1)
      
      Canzoneri-Fitzpatrick

Bill Amendments

Original

A (Active)

co-Sponsors

2023-S5517 - Details

See Assembly Version of this Bill:: A2367
Current Committee:: Senate Rules
Law Section:: Public Health Law
Laws Affected:: Amd §2509, Pub Health L
Versions Introduced in 2021-2022 Legislative Session:: S8866, A9714

2023-S5517 - Summary

Requires the advisory council on maternal mortality and morbidity to undertake a review of the cesarean births at hospitals in the state; requires two licensed midwives to be on the advisory council.

2023-S5517 - Sponsor Memo

                                 
BILL NUMBER: S5517

SPONSOR: BROUK
 
TITLE OF BILL:

An act to amend the public health law, in relation to establishing the
cesarean births review board

 
PURPOSE OR GENERAL IDEA OF BILL:

To create a cesarean births review board for the purpose of lowering
cesarean birth rates and improving maternal health

 
SUMMARY OF KEY PROVISIONS:

Section one of the bill amends public health law to establish a "cesare-
an births review board." The board will undertake a review of the rate
of cesarean births at hospitals across the state and consider several
factors that may impact the frequency of this procedure. The board will
issue a final report and make recommendations related to the impact
cesarean births have on birthing people and best practices that can be
implemented to reduce the rate of cesarean births and improve overall

maternal health in the state. A copy of the final report must be posted
on the Department of Health website.

Section two provides the effective date.

 
JUSTIFICATION:

The rate of cesarean birth in this state, and in this country, is not
nearly spoken about enough. Since the 1970s, the national rate of cesa-
rean births has increased by 500% which translates to about 1 in 3
babies delivered via C-section presently, compared to just 1 in 20
babies in the mid-1970s. Despite this growing trend, research demon-
strates there is no evidence that cesarean births provide any benefit to
the mother or newborn when the procedure is not required, in fact, it is
quite the opposite.

Currently, New York ranks 12th in the nation, where approximately 33% of
all deliveries in the state are Cesarean. New York's cesarean birth rate
greatly exceeds the World Health Organization's and CDC's ideal rate
which is between 10 and 15 percent. While the state average is around
33%, it is important to note that cesarean birth rates vary greatly
across hospitals, ranging between 7% and 70% depending on what hospital
a birthing person goes to.

Further, studies have found that cesarean birth rates in hospitals are
directly linked to higher maternal death rates and higher costs for
healthcare. The increase in cesarean rates in the U.S. is linked to an
increase in maternal deaths overall as the procedure can lead to neona-
tal respiratory problems and maternal complications. In fact, cesareans
can account for three of the top six leading causes of maternal mortali-
ty-hemorrhage, complications of anesthesia, and infection. Many of these
maternal deaths are preventable given WHO's recommended rate of cesarean
deliveries.

Additionally, there is an alarming disparity in cesarean birth rates
among different birthing populations. Minority (non-Hispanic black,
Hispanic/Latina, Indigenous, and low socio-economic status) birthing
people receive cesareans at a significantly higher rate than non-Hispan-
ic white birthing people, which is also an indicator of low-quality
maternity care. Moreover, black birthing people are more likely to
receive a cesarean overall and importantly, they are also more likely to
undergo repeated cesareans compared to other birthing people, which
further increases the risk of mortality. In fact, in the U.S., black
birthing people die from pregnancy-related causes at higher rates and
have a four times greater risk of maternal death, more than any other
racial or ethnic group.

This bill would establish a "cesarean births review board" comprised of
experts in the field of maternal mortality, women's health and public
health, and must include healthcare professionals who are representative
of the racial, ethnic, and socioeconomic diversity of birthing people in
the state. The board will undertake a review of the rate of cesarean
births at hospitals across the state and consider several factors that
may impact the frequency of this procedure. The board will issue a final
report and make recommendations related to the impact cesarean births
have on birthing people and best practices that can be implemented to
reduce the rate of cesarean births and improve overall maternal health
in the state.

 
LEGISLATIVE HISTORY:

S8866 of 2022. Referred to Women's Issues.

 
FISCAL IMPLICATIONS:

To be determined.

 
EFFECTIVE DATE:
This act shall take effect immediately.

2023-S5517 - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5517
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                               March 7, 2023
                                ___________
 
 Introduced  by  Sens.  BROUK,  CLEARE,  RAMOS  -- read twice and ordered
   printed, and when printed to be committed to the Committee on  Women's
   Issues
 
 AN  ACT  to amend the public health law, in relation to establishing the
   cesarean births review board
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  The  public health law is amended by adding a new section
 2500-n to read as follows:
   § 2500-N. CESAREAN BIRTHS REVIEW BOARD. 1. THERE IS HEREBY ESTABLISHED
 IN THE DEPARTMENT THE CESAREAN BIRTHS REVIEW BOARD, HEREINAFTER REFERRED
 TO AS THE "BOARD". THE MEMBERS  OF  THE  BOARD  SHALL  BE  COMPRISED  OF
 EXPERTS IN THE FIELDS OF MATERNAL MORTALITY, MATERNAL HEALTH, AND PUBLIC
 HEALTH.    THE  APPOINTMENT OF ANY MEMBER OF THE BOARD SHALL BE BASED IN
 PART ON THE OBJECTIVE OF ENSURING THAT THE BOARD  INCLUDES  EXPERTS  WHO
 ARE REPRESENTATIVE OF THE RACIAL, ETHNIC, AND SOCIOECONOMIC DIVERSITY OF
 THE BIRTHING PEOPLE OF THE STATE.
   2.  THE BOARD SHOULD BE COMPOSED OF TWELVE MEMBERS WHICH SHALL INCLUDE
 EIGHT MEMBERS TO BE APPOINTED BY THE GOVERNOR AS FOLLOWS:  TWO  LICENSED
 MIDWIVES  IN  THE STATE; TWO LICENSED AND REGISTERED NURSES SPECIALIZING
 IN OBSTETRICS IN THE STATE; TWO PHYSICIANS  SPECIALIZING  IN  OBSTETRICS
 AND GYNECOLOGY LICENSED AND REGISTERED TO PRACTICE IN THE STATE; AND TWO
 REPRESENTATIVES  OF A WOMEN'S MATERNAL HEALTH ORGANIZATION THAT OPERATES
 IN THE STATE; AND FOUR ADDITIONAL MEMBERS, TWO APPOINTED ON  THE  RECOM-
 MENDATION  OF THE TEMPORARY PRESIDENT OF THE SENATE AND TWO APPOINTED ON
 THE RECOMMENDATION OF THE SPEAKER OF THE ASSEMBLY.   THE GOVERNOR  SHALL
 DESIGNATE  THE  COMMISSIONER,  OR THEIR DESIGNEE, AS CHAIR OF THE BOARD.
 MEMBERS OF THE BOARD SHALL RECEIVE NO COMPENSATION  FOR  THEIR  SERVICES
 BUT  MAY BE REIMBURSED FOR NECESSARY AND ACTUAL EXPENSES INCURRED IN THE
 PERFORMANCE OF THEIR DUTIES HEREUNDER.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD04565-01-3
 S. 5517                             2

 
   3. THE BOARD SHALL UNDERTAKE A REVIEW OF CESAREAN BIRTHS AT  HOSPITALS
 IN  THE STATE. THE BOARD SHALL ISSUE A FINAL REPORT AND MAKE RECOMMENDA-
 TIONS TO REDUCE THE RATE OF CESAREAN BIRTHS  IN  THE  STATE.  THE  BOARD
 SHALL CONSIDER FACTORS INCLUDING, BUT NOT LIMITED TO:
   (A) THE PRIMARY AND REPEAT CESAREAN BIRTH RATES AMONG HOSPITALS IN THE
 STATE;
   (B)  THE HOSPITALS IN THE STATE THAT ALLOW OR ENCOURAGE VAGINAL BIRTHS
 AFTER CESAREAN BIRTHS;
   (C) THE RATE OF VAGINAL BIRTHS AFTER CESAREAN BIRTHS  AMONG  HOSPITALS
 IN THE STATE;
   (D) THE RATE OF VAGINAL BIRTHS AFTER CESAREAN BIRTHS THAT WERE OFFERED
 BY HOSPITALS IN THE STATE BUT DECLINED BY THE BIRTHING PERSON;
   (E)  THE  RATE  OF  VAGINAL  BIRTHS  AFTER  CESAREAN  BIRTHS THAT WERE
 ATTEMPTED BUT FAILED AMONG HOSPITALS IN THE STATE;
   (F) THE TIME OF DAY UNPLANNED CESAREAN BIRTHS OCCUR IN HOSPITALS,  AND
 WHETHER SUCH CORRELATES WITH THE RATE OF CESAREAN BIRTHS IN A HOSPITAL;
   (G)  THE  NUMBER  OF BIRTHING PEOPLE WHO ELECT TO HAVE MIDWIVES ATTEND
 LABOR AND DELIVERY IN HOSPITALS IN THE STATE;
   (H) THE FREQUENCY OF MIDWIFERY CARE DURING LABOR IN  HOSPITALS  ACROSS
 THE  STATE  AND  WHAT  IMPACT,  IF ANY, THIS HAS ON THE RATE OF CESAREAN
 BIRTHS; AND
   (I) THE NUMBER OF BIRTHING PEOPLE WHO WERE INFORMED  BY  THEIR  HEALTH
 CARE  PROVIDER  ABOUT  THE  POTENTIAL  RISKS, BENEFITS, AND ALTERNATIVES
 RELATED TO CESAREAN BIRTHS BEFORE LABOR.
   4. THE BOARD MAY REQUEST AND  SHALL  RECEIVE  UPON  REQUEST  FROM  ANY
 DEPARTMENT,  DIVISION,  BOARD,  BUREAU, COMMISSION, LOCAL HEALTH DEPART-
 MENTS OR ANY OTHER AGENCY IN THE STATE OR POLITICAL SUBDIVISION  THEREOF
 OR  ANY PUBLIC AUTHORITY, SUCH INFORMATION, INCLUDING BUT NOT LIMITED TO
 MEDICAL RECORDS, BIRTH RECORDS, AND ANY OTHER INFORMATION THAT WILL HELP
 THE DEPARTMENT UNDER THIS SECTION TO PROPERLY CARRY OUT  ITS  FUNCTIONS,
 POWERS AND DUTIES.
   5. THE BOARD SHALL, WITHIN EIGHTEEN MONTHS OF CONVENING, ISSUE A FINAL
 REPORT  ON  ITS FINDINGS AND RECOMMENDATIONS TO THE GOVERNOR, SPEAKER OF
 THE ASSEMBLY, AND TEMPORARY PRESIDENT OF THE  SENATE.  THE  BOARD  SHALL
 POST A COPY OF SUCH REPORT ON THE DEPARTMENT'S WEBSITE.
   6.    THE  BOARD  SHALL KEEP CONFIDENTIAL ANY INFORMATION COLLECTED OR
 RECEIVED UNDER THIS SECTION THAT INCLUDES PERSONAL IDENTIFYING  INFORMA-
 TION  OF  THE BIRTHING PERSON, HEALTH CARE PRACTITIONER OR PRACTITIONERS
 OR ANYONE ELSE INDIVIDUALLY NAMED IN SUCH INFORMATION, AS  WELL  AS  THE
 HOSPITAL  OR  FACILITY  THAT  TREATED THE BIRTHING PERSON, AND ANY OTHER
 INFORMATION SUCH AS GEOGRAPHIC LOCATION THAT MAY INADVERTENTLY  IDENTIFY
 THE  BIRTHING PERSON, PRACTITIONER OR FACILITY, AND SHALL USE THE INFOR-
 MATION PROVIDED OR RECEIVED UNDER THIS SECTION SOLELY FOR  THE  PURPOSES
 OF IMPROVEMENT OF THE QUALITY OF MATERNAL HEALTH CARE.
   § 2. This act shall take effect immediately.

co-Sponsors

View additional co-sponsors

2023-S5517A (ACTIVE) - Details

See Assembly Version of this Bill:: A2367
Current Committee:: Senate Rules
Law Section:: Public Health Law
Laws Affected:: Amd §2509, Pub Health L
Versions Introduced in 2021-2022 Legislative Session:: S8866, A9714

2023-S5517A (ACTIVE) - Summary

Requires the advisory council on maternal mortality and morbidity to undertake a review of the cesarean births at hospitals in the state; requires two licensed midwives to be on the advisory council.

2023-S5517A (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S5517A

SPONSOR: BROUK
 
TITLE OF BILL:

An act to amend the public health law, in relation to requiring the
advisory council on maternal mortality and morbidity to undertake a
review of the cesarean births at hospitals in the state

 
PURPOSE OR GENERAL IDEA OF BILL:

To create a cesarean births review board for the purpose of lowering
cesarean birth rates and improving maternal health

 
SUMMMARY OF KEY PROVISIONS:

Section one of the bill amends public health law to expand the scope of
the maternal mortality review board to assess whether there was a vagi-
nal or cesarean birth when assessing cause of death.

Section two of the bill amends public health law to require the board to
assess whether there was a vaginal or cesarean birth when reporting on

each maternal death case.

Section three of the bill amends public health law to require the advi-
sory council on maternal mortality and morbidity to undertake a review
of the cesarian births at hospitals in the state. The council shall
issue a final report. and make recommendations to reduce the rate of
cesarean births in the state.

Section four provides the effective date.

 
JUSTIFICATION:

The rate of cesarean birth in this state, and in this country, is not
nearly spoken about enough. Since the 1970s, the national rate of cesa-
rean births has increased by 500% which translates to about 1 in 3
babies delivered via C-section presently, compared to just 1 in 20
babies in the mid-1970s. Despite this growing trend, research demon-
strates there is no evidence that cesarean births provide any benefit to
the mother or newborn when the procedure is not required, in fact, it is
quite the opposite.

Currently, New York ranks 12th in the nation, where approximately 33% of
all deliveries in the state are Cesarean. New York's cesarean birth rate
greatly exceeds the World Health Organization's and CDC's ideal rate
which is between 10 and 15 percent. While the state average is around
33%, it is important to note that cesarean birth rates vary greatly
across hospitals, ranging between 7% and 70% depending on what hospital
a birthing person goes to.

Further, studies have found that cesarean birth rates in hospitals are
directly linked to higher maternal death rates and higher costs for
healthcare. The increase in cesarean rates in the U.S. is linked to an
increase in maternal deaths overall as the procedure can lead to neona-
tal respiratory problems and maternal complications. In fact, cesareans
can account for three of the top six leading causes of maternal mortali-
ty-hemorrhage, complications of anesthesia, and infection. Many of these

maternal deaths are preventable given WHO's recommended rate of cesarean
deliveries.

Additionally, there is an alarming disparity in cesarean birth rates
among different birthing populations. Minority (non-Hispanic black,
Hispanic/Latina, Indigenous, and low socio-economic status) birthing
people receive cesareans at a significantly higher rate than non-Hispan-
ic white birthing people, which is also an indicator of low-quality
maternity care. Moreover, black birthing people are more likely to
receive a cesarean overall and importantly, they are also more likely to
undergo repeated cesareans compared to other birthing people, which
further increases the risk of mortality. In fact, in the U.S., black
birthing people die from pregnancy-related causes at higher rates and
have a four times greater risk of maternal death, more than any other
racial or ethnic group.

This bill would establish a "cesarean births review board" comprised of
experts in the field of maternal mortality, women's health and public
health, and must include healthcare professionals who are representative
of the racial, ethnic, and socioeconomic diversity of birthing people in
the state. The board will undertake a review of the rate of cesarean
births at hospitals across the state and consider several factors that
may impact the frequency of this procedure. The board will issue a final
report and make recommendations related to the impact cesarean births
have on birthing people and best practices that can be implemented to
reduce the rate of cesarean births and improve overall maternal health
in the state.

 
LEGISLATIVE HISTORY:

S8866 of 2022. Referred to Women's Issues.

 
FISCAL IMPLICATIONS:

To be determined.

 
EFFECTIVE DATE:
This act shall take effect immediately.

2023-S5517A (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  5517--A
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                               March 7, 2023
                                ___________
 
 Introduced  by  Sens.  BROUK,  CLEARE,  RAMOS, SALAZAR -- read twice and
   ordered printed, and when printed to be committed to the Committee  on
   Women's   Issues   --  committee  discharged,  bill  amended,  ordered
   reprinted as amended and recommitted to said committee
 
 AN ACT to amend the public health law,  in  relation  to  requiring  the
   advisory  council  on  maternal mortality and morbidity to undertake a
   review of the cesarean births at hospitals in the state
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Paragraph  (a)  of  subdivision  1 of section 2509 of the
 public health law, as amended by chapter 142 of the  laws  of  2019,  is
 amended to read as follows:
   (a) There is hereby established in the department the maternal mortal-
 ity review board for the purpose of reviewing maternal deaths and mater-
 nal  morbidity  and  developing  and disseminating findings, recommenda-
 tions, and best practices to contribute to the  prevention  of  maternal
 mortality  and  morbidity.  The  board  shall assess the cause of death,
 INCLUDING WHETHER THERE WAS A VAGINAL OR CESAREAN BIRTH, factors leading
 to death and preventability for each maternal death reviewed and, in the
 discretion of the board, cases of severe maternal morbidity,  and  shall
 develop  and  disseminate  strategies  for reducing the risk of maternal
 mortality and morbidity, including risk resulting from racial, economic,
 or other disparities. The commissioner may  delegate  the  authority  to
 conduct maternal mortality reviews.
   §  2.  Paragraph  (a)  of  subdivision 5 of section 2509 of the public
 health law, as amended by chapter 142 of the laws of 2019, is amended to
 read as follows:
   (a) shall make and report findings and recommendations to the  commis-
 sioner,  and  in  the case of the city board to the commissioner and the
 city commissioner regarding the  cause  of  death,  factors  leading  to
 death, and preventability of each maternal death case, INCLUDING WHETHER

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD04565-02-3

 S. 5517--A                          2
 
 THERE  WAS A VAGINAL OR CESAREAN BIRTH, and each case of severe maternal
 morbidity reviewed by the board, by reviewing relevant  information  for
 each  case in the state or the city of New York, as the case may be, and
 consulting  with  experts as needed to evaluate the information for each
 death; and shall provide such findings  and  recommendations,  including
 best  practices and strategies for reducing the risk of maternal mortal-
 ity and morbidity, to  the  advisory  council;  provided  that  material
 provided  to the advisory council shall not include any information that
 would be confidential under this section;
   § 3. Paragraphs (b) and (d) of subdivision 8 of section  2509  of  the
 public  health  law,  as amended by chapter 142 of the laws of 2019, are
 amended to read as follows:
   (b) The advisory council:
   (i) may review the findings of the boards;
   (ii) may develop recommendations  on  policies,  best  practices,  and
 strategies to prevent maternal mortality and morbidity;
   (iii) may hold public hearings on those matters;
   (iv)  may make findings and issue reports, including an annual report,
 on such matters; [and]
   (v) may request and shall receive the assistance of the  commissioner,
 the  city commissioner, and the boards in carrying out its functions[.];
 AND
   (VI) SHALL UNDERTAKE A REVIEW OF CESAREAN BIRTHS AT HOSPITALS  IN  THE
 STATE.  THE  COUNCIL SHALL ISSUE A FINAL REPORT AND MAKE RECOMMENDATIONS
 TO REDUCE THE RATE OF CESAREAN BIRTHS IN THE STATE.  THE  COUNCIL  SHALL
 CONSIDER  FACTORS  INCLUDING, BUT NOT LIMITED TO: THE PRIMARY AND REPEAT
 CESAREAN BIRTH RATES AMONG HOSPITALS IN THE STATE; THE HOSPITALS IN  THE
 STATE  THAT ALLOW OR ENCOURAGE VAGINAL BIRTHS AFTER CESAREAN BIRTHS; THE
 RATE OF VAGINAL BIRTHS AFTER CESAREAN  BIRTHS  AMONG  HOSPITALS  IN  THE
 STATE;  THE  RATE  OF  VAGINAL  BIRTHS  AFTER  CESAREAN BIRTHS THAT WERE
 OFFERED BY HOSPITALS IN THE STATE BUT DECLINED BY THE  BIRTHING  PERSON;
 THE RATE OF VAGINAL BIRTHS AFTER CESAREAN BIRTHS THAT WERE ATTEMPTED BUT
 FAILED  AMONG HOSPITALS IN THE STATE; THE TIME OF DAY UNPLANNED CESAREAN
 BIRTHS OCCUR IN HOSPITALS, AND WHETHER SUCH CORRELATES WITH THE RATE  OF
 CESAREAN  BIRTHS  IN A HOSPITAL; THE NUMBER OF BIRTHING PEOPLE WHO ELECT
 TO HAVE MIDWIVES ATTEND LABOR AND DELIVERY IN HOSPITALS  IN  THE  STATE;
 THE  FREQUENCY  OF  MIDWIFERY  CARE DURING LABOR IN HOSPITALS ACROSS THE
 STATE AND WHAT IMPACT, IF ANY, THIS HAS ON THE RATE OF CESAREAN  BIRTHS;
 AND THE NUMBER OF BIRTHING PEOPLE WHO WERE INFORMED BY THEIR HEALTH CARE
 PROVIDER  ABOUT  THE POTENTIAL RISKS, BENEFITS, AND ALTERNATIVES RELATED
 TO CESAREAN BIRTHS BEFORE LABOR.
   (d) The members of the council shall be comprised of multidisciplinary
 experts INCLUDING TWO LICENSED MIDWIVES and lay persons knowledgeable in
 the field of maternal mortality, women's health and  public  health  and
 shall  include  members  who serve and are representative of the racial,
 ethnic, and socioeconomic diversity of the  women  and  mothers  of  the
 state,  and  to  the extent possible, the medically underserved areas of
 the state or areas of the state with disproportionately high occurrences
 of maternal mortality or morbidity.
   § 4. This act shall take effect immediately.

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Senate Bill S5517A

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Sponsored By

Current Bill Status - In Senate Committee Rules Committee

Bill Amendments

co-Sponsors

2023-S5517 - Details

2023-S5517 - Summary

2023-S5517 - Sponsor Memo

2023-S5517 - Bill Text download pdf

co-Sponsors

2023-S5517A (ACTIVE) - Details

2023-S5517A (ACTIVE) - Summary

2023-S5517A (ACTIVE) - Sponsor Memo

2023-S5517A (ACTIVE) - Bill Text download pdf

Comments