Your Health and the Law A Guide for Teens

1. Seventh Edition Your Health and the LawA Guide for Teens

2. Your Health and the LawA Guide for Teens Purposes: • Educate teens about their rights • Empower teens to make medical decisions • Educate parents, health providers, educators, and courts about teens’ rights • Basic information – not legal advice

3. Teens and Medical Care • One of least likely groups in U.S. to have healthcare access* • Main reason: concerns about confidentiality and parents being informed • But: law sometimes grants teens confidentiality and ability to consent without parents • In this presentation: when can teens make own medical decisions? *See Charles Irwin, et al., Preventive Care for Adolescents: Few Get Visits and Fewer Get Services, 123 Pediatrics 565 (2009).

4. Issues Covered • Confidentiality • Consent • Sexual Health • Mental Health • Substance Abuse • Minors and Violence

5. Basic Definitions • What is a minor? • Anyone between birth and 18 years old • What is an adult? • Anyone older than 18 - Except in some cases of mental or physical disabilities • What is a “parent”? Can be minor’s natural parent, legal guardian, or an adult with legal responsibility for a minor

6. Confidentiality • Erin asks her doctor for a confidential pregnancy test. Her friend calls later to find out the results for her. Can the doctor disclose the results to Erin’s friend?

7. Confidentiality • Erin asks her doctor for a confidential pregnancy test. Her friend calls later to find out the results for her. Can the doctor disclose the results to Erin’s friend? Not without Erin’s permission. The information is confidential and cannot be disclosed to anyone but Erin.

8. Confidentiality • Information about treatment cannot be disclosed without permission of person who consented to care (minor or parent), including: • Doctor's records • School records • HIPAA sets national privacy standards for health care. • When law is unclear: doctors decide

9. Confidentiality • Information may be disclosed: • To local, state, or federal government for reporting • When a third party is at risk (STD, HIV) • As part of a court proceeding • When abuse or danger to minor is suspected

10. Confidentiality • Nurse Smith is a school nurse. One of her patients, a 16-year-old, has a bad case of the flu and wants the nurse to call a doctor. Can Nurse Smith give the student’s medical files to the doctor?

11. Confidentiality • Nurse Smith is a school nurse. One of her patients, a 16-year-old, has a bad case of the flu and wants the nurse to call a doctor. Can Nurse Smith give the student’s medical files to the doctor? Probably not. In certain cases, a minor can authorize the disclosure of health information. However, this is generally up to the parents.

12. Confidentiality • Maria, who is 16, receives confidential medical treatment and wants to pay for the treatment through her parents' insurance plan. Will information about her be disclosed to her parents?

13. Confidentiality • Maria, who is 16, receives confidential medical treatment and wants to pay for the treatment through her parents' insurance plan. Will information about her be disclosed to her parents? Maybe. Some information may be disclosed to her parents during the insurance reimbursement process. Maria should ask the insurance company about the risks of disclosure beforehand.

14. Consent • What is informed consent? • Patient understands and voluntarily agrees to a suggested treatment • Written consent is best, but verbal consent is also possible.

15. Consent • Informed about what? • Necessity • Nature and purpose of procedure • Risks and benefits • Possible alternatives • Cost • Post-procedure care • Second opinion

16. Minors and Consent • Which treatments can minors receive without parental consent? • Emergency health care • Limited outpatient mental health care • Counseling for eating disorders • Alcohol and drug abuse treatment • Testing for HIV/AIDS • Some family planning services • Contract is enforceable • Responsible for payment

17. Parents and Consent • Which treatments need parental consent? • Abortion • Exception: Judicial Bypass • Mental Health Care • Inpatient care • Medication • Sessions have expired

18. Parents and Consent • Parents who do not consent to medically necessary care could be charged with neglect or child endangering. • Parents do not have the right to refuse medical treatment for their child based on religious beliefs.

19. Consent • What is emancipation? Definition: when a minor is considered independent and can legally consent to his or her own medical treatment. • No specific law grants this right in Ohio • A teen is not considered emancipated in Ohio even when financially independent. • Emancipation can be granted when a teen • marries • enlists in armed services

20. Consent • Marriage in Ohio • Only between man and woman • Male must be 18; female at least 16 • Everyone under 18 needs parental consent

21. Sexual Health • A 14-year-old girl, Sally, wants to get a prescription for the pill. Does she need parental consent?

22. Sexual Health • A 14-year-old girl, Sally, wants to get a prescription for the pill. Does she need parental consent? No. Certain government programs provide for contraceptives, including the pill, to be made available to minors without parental consent. Private physicians may provide contraceptives to their minor patients without parental consent if the patient is mature enough to give his or her own consent.

23. Sexual Health • Minors do not need parental consent for: • Testing and treatment of STDs, HIV/AIDS • Emergency Contraception (EC) – must be used within 72 hours of intercourse • Birth control • Pregnancy care • Limited counseling sessions • Substance abuse/drinking counseling

24. Sexual Health • Anonymous vs. Confidential Testing • Anonymous: Recorded by code number • most private • Confidential: Recorded in patient's medical record • More easily accessible

25. Sexual Health • HIV/AIDS Legal Requirement in Ohio • An HIV-positive person must inform the following people of his or her status or face criminal charges: • Future sexual partners • Anyone with whom he/she intends to share a needle • Health workers will notify past sexual partners of possible infection

26. Sexual Health • A public health officer tells Larrythat he may have an STD. Can the officer tell Larry who transmitted it?

27. Sexual Health • A public health officer tells Larrythat he may have an STD. Can the officer tell Larry who transmitted it? No. The officer can reveal only that Larry is at risk. He or she cannot reveal the name of the contact.

28. Sexual Health • Disclosure of HIV/AIDS information with written release of minor may be made to: • Physician • Police officer • Legal guardian • Spouse or sexual partner

29. Sexual Health • Disclosure of HIV/AIDS information without written release of minor: • In emergency for patient or child of patient • Government health officer

30. Sexual Health • Kateis 17. She had sex last night with her boyfriend and the condom broke. She is scared that she will get pregnant and her parents will find out. Is there anything she can do?

31. Sexual Health • Kateis 17. She had sex last night with her boyfriend and the condom broke. She is scared that she will get pregnant and her parents will find out. Is there anything she can do? Yes. Kate can use emergency contraception (EC), which is also called “the morning after pill.” EC stops pregnancy from happening if it is used no later than 72 hours after sex. Because Kate is 17 she can purchase EC over the counter. She does not need parental consent to get EC.

32. Sexual Health • Rebecca is 16. She is from New York but is staying in Ohio for the summer for a music program. She has found out that she is pregnant and wants to terminate the pregnancy. Does she need to tell her parents?

33. Sexual Health • Rebecca is 16. She is from New York but is staying in Ohio for the summer for a music program. She has found out that she is pregnant and wants to terminate the pregnancy. Does she need to tell her parents? Yes. Although teens may undergo abortions in New York without parental consent, Rebecca is subject to Ohio law while she is visiting the state. A parent, custodian, or guardian of a person 17 or younger must consent to a minor’s abortion. If a parent will not consent to an abortion, the minor can seek a judicial bypass.

34. Sexual Health • Abortion • Need parental consent (unless exempt) • Must meet physician 24 hours in advance • Cannot be forced • Cannot use state or local public funds to subsidize cost of abortion unless needed to save physical or mental health of the mother

35. Sexual Health • Abortion - Judicial Bypass • To obtain an abortion without parental consent, a minor must go to the juvenile court in the county where she lives or a bordering county and convince a judge that: • Minor is mature enough to decide on her own • There is a compelling reason minor should be able to decide • Many women’s medical service providers can assist with this process.

36. Mental Health • Rahim is 15. He is severely depressed and wants mental health treatment. His parents refuse to allow it. Can the doctor treat Rahim?

37. Mental Health • Rahim is 15. He is severely depressed and wants mental health treatment. His parents refuse to allow it. Can the doctor treat Rahim? Yes, if Rahim consents to the treatment.

38. Mental Health • Minors may receive outpatient counseling without parental consent: • Must be at least 14 years old • Limited to 6 sessions or 30 days, whichever comes first • No medication

39. Mental Health • Parents will be notified of mental health treatment if: • Minor consents to notification • Minor is likely to harm someone • Provider must first inform minor that parents will be notified • After treatment limit: • Stop care or parental consent needed

40. Substance Abuse • Leeis 16. He is thinking about talking to a school counselor about his drinking problem but is scared that his parents will be notified. Can he receive counseling without parental consent?

41. Substance Abuse • Leeis 16. He is thinking about talking to a school counselor about his drinking problem but is scared that his parents will be notified. Can he receive counseling without parental consent? Yes. A minor does not need parental consent to receive counseling. Whether or not the counselor decides to treat Lee, his parents cannot be informed without his permission.

42. Substance Abuse • Alcohol and Drugs: • No parental consent needed for treatment • Records stay confidential • Cigarettes and Tobacco • Illegal for minors to use, buy, or obtain

43. Minors and Violence • Child Abuse • When an adult with custody of a minor harms the minor or allows the minor to be in a harmful situation. • Focuses on parent/caretaker's treatment of minor • Responsibility to report suspected abuse • Child Abuse Prevention and Treatment Act (CAPTA) • You can be prosecuted for knowingly lying about abuse.

44. Minors and Violence • Sexual Violence • Violation and abuse of a person's body • Most common forms are rape and sexual assault • Victims should seek medical care as soon as possible

45. Minors and Violence • Rape: • Any forced penetration, including intercourse, oral sex and anal sex. Rape is always wrong and should be reported immediately. • Sexual Assault: • Inappropriate touching, especially of sexual organs.

46. Minors and Violence • Medical Examination of a Minor: • Minor can consent to an examination for the purpose of gathering physical evidence • Ohio law provides free emergency room examinations to all victims of sexual assault offenses • Parental consent not required • Hospital must give the parents written notification of the examination

47. Your Health and the LawA Guide for Teens Summary • Minors who are married or in the armed forces can consent to all of their own health care • All others can consent to only certain procedures • All must understand risk and benefits of treatment in order to give “informed consent” • Adults must protect confidentiality

48. Resources • Center for Disease Control • 1-800-227-8922. • Women, Infants and Children (WIC) • 614-644-8006 • National Domestic Violence Hotline • 1-800-799-SAFE • National Hopeline Network: • 1-800-SUICIDE • www.hopeline.com • Anorexia Nervosa and Associated Disorders (ANAD) • 847-831-3438 • www.anad.org

49. Credits and Ordering • Thank you: • Friedman-Klarreich Family Foundation • ACLU volunteers and student interns • Ordering: • www.acluohio.org (publications) • (216) 472-2220