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A new bill would make North Carolina the only state in the country to require teens to get parental approval for mental health, substance abuse or reproductive health care.
By Rose Hoban
A bill that would require adolescents seeking health care to get parental consent before talking to a doctor advanced Tuesday in the General Assembly.
The bill, House Bill 693, would make North Carolina the only state in the country to require teens under the age of 18 to be accompanied by either a parent or guardian when seeking care for a pregnancy, sexually transmitted infection, substance-abuse problem or mental health issue.
Teens would also be allowed to receive health care in those instances if they present a notarized permission letter from a guardian or petition a juvenile court judge.
“This bill reinforces the longstanding legal presumption that fit parents act in the best interests of their children,” said Jere Royall of the N.C. Family Policy Council, who spoke in support of the bill.
“Involving parents in these important health care decisions for their children is a positive step in restoring the fundamental right of parents to care for their own children.”
Children’s advocates decried the measure.
“We appreciate the intent of the sponsors to try and encourage parents to be involved in the medical care of their children,” said Rob Thompson, head of the Covenant with North Carolina’s Children, an advocacy organization.
His concern, he said, was for the teens’ health and safety.
“We don’t think that any child who is unwilling or unable to speak to their parents should be denied medical treatment for these conditions,” Thompson said.
He said thousands of youth from across the state who are abused by their parents should not be required to go to those parents to get consent for care.
Many parents are not there,” Rep. Alma Adams (D-Greensboro) said, “and some of these kids are being abused. We need protection for them, and allow them to seek out medical help.”
What role for parents?
Since 1971, minors have been allowed to receive counseling and treatment for sexually transmitted diseases, pregnancy, substance abuse and emotional problems without parental consent.
Lawmakers in support of the measure argued that since that time teenagers have been encouraged by society not to go to parents when they have problems.
“Seventy-five percent of the kids have been given that idea that mom and dad are not that necessary in their lives, and that you don’t always have to go to mom and dad,” said Marilyn Avila (R-Raleigh), “and I think it’s an insidious kind of thing.”
Avila said society has undermined the authority of families and parents.
“There’s an attempt here to legislate a model family, but I don’t think that’s a reality,” said John Rusher, president of the N.C. Pediatric Society, who practices in Raleigh.
His organization, along with the N.C. Medical Society, the N.C. Psychological Association and the N.C. Psychiatric Association, all oppose the bill.
Rusher said when young people come to him with problems, he often ends up helping the kids talk to their parents about those problems.
“Say someone has a mental health or emotional issue,” Rusher said; “that child needs care, maybe needs counseling from a psychologist, or needs alcohol-abuse or substance-abuse counseling. I can’t arrange that by myself. I’m going to involve the parent anyway.
“If we put a cloud on that initial access, you’re going to have kids who are just not going to get treated.”
Some lawmakers pointed out that often parents pay for these medical encounters, a fact confirmed by Rusher.
“The reality of the situation is, if they’re getting the bill, we’re going to do everything we can to that encounter to include the parents in the first place,” Rusher said.
Other lawmakers expressed concern about parental liability if kids have side effects or problems with medication after being treated.
“If my child goes and gets treatment for something like HIV and I don’t know, and someone else gets infected or a medical bill comes back, I’d still be liable?” asked Rep. Ruth Samuelson (R-Charlotte).
Legislative staff responded that liability would be dependent on the circumstances.
Staff pointed out that for patients receiving federal Title X family-planning services or Medicaid, federal law forbids requiring parental consent.
Pregnancy and disease rates
During 2011 and 2012, more than 5,000 North Carolinians under the age of 18 were diagnosed with sexually transmitted diseases including chlamydia, gonorrhea, syphilis and HIV, said state communicable disease chief Evelyn Foust.
“Over time, rates of sexually transmitted diseases go up and down,” she said. “In the 1990s, there were extremely high rates of syphilis in North Carolina – thousands of cases.
We have 35,000 people now living with HIV, and we’ve been concerned in the past few years that the age for acquiring HIV has been trending downward.”
Rusher said he worries particularly about chlamydia.
“We’ve seen a huge increase here in Wake County of chlamydia, and it crosses all socioeconomic lines,” he said.
Rusher explained that often, in both males and females, the disease is asymptomatic.
“It can progress in females to pelvic inflammatory disease, which can be a situation where they need inpatient hospital care, IV antibiotics,” he said. “And sometimes it results in permanent damage to reproductive organs.”
“Teen-pregnancy rates have decreased over the past decade, and the abortion rates have not increased,” said Neva Bartholomew, a community pediatrician from Chapel Hill.
The state had its lowest teen-pregnancy rates in more than 30 years, dropping from a high of 105 per thousand girls ages 15 to 19 in 1990 to 43.8 per thousand girls of the same age in 2011. The abortion rate was also at its lowest since 1980.
That comes from access to contraceptive services and counseling about sexual activity, Bartholomew said.
Rep. Verla Insko (D-Chapel Hill) remembered being on the local school board when, in 1971, the bill to allow minors to seek care without parental consent was passed.
“We had serious problems,” Insko said. “Teenagers were delaying treatment, spreading venereal disease … committing suicide, because, in some cases, they couldn’t talk to parents.
If you repeal this, those serious problems will return.”
That concern was dismissed by Tami Fitzgerald of the N.C. Values Coalition, who called the bill a “common sense bill that puts control back in the hands of their parents for medical treatment of their minor children.”
The measure passed the House Health Committee by a vote of 14-8.
Cover photo credit: Frank de Kleine, flickr creative commons
Minor Consent for Health Care, A Review of State Laws (PDF)