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Riders 14 & 15 on the Texas Appropriations Bill are Classic Examples of Bad Public Health Policy and Should be Removed! Download this document in Microsoft Word Note: Riders 14 & 15 have been renumbered once again as of May 14. They are now Riders 29 & 30 respectively. However, they appear with their old numbers in this document. General Background: In 1999, during the 77th Session, Sen. Ogden succeeded in placing two riders, then Riders 17 and 18, on the Appropriations Bill for SGY 2000 and 2001. Rider 17 would have eliminated access to confidential family planning services, including screening for sexually transmitted diseases and pregnancy prevention, for adolescents as long as enforcement did not interfer with federal funding. Rider 18 required that agencies and individuals contracting with the Texas Department of Health (TDH) report teen sexual activity to law enforcement agencies. Both of these riders still appear in the Appropriations Bill now under consideration for SFY 2002 and 2003, but they have been renumbered. They now appear as Riders 14 and 15. TDH implemented Rider 15, formerly Rider 18, in December, 2000. They are requiring that a checklist be completed on all adolescents under age 14, and anyone found to be pregnant or to have a sexually transmitted infection must be reported to law enforcement or, if a family member is involved, to the Texas Department of Protective and Regulatory Services. TDH has yet to implement Rider 14, formerly Rider 17, but they have contacted federal funding sources to see if full implementation would jeopardize federal funding. TDH has learned that two sources of federal monies have statutory mandates requiring confidential services for minors, and two other sources do not have such requirements. Rider 14 Text: "Medical Treatment. The Texas Department of Health may distribute or provide funds only to recipients which comply with the consent provisions of Chapter 32 of the Texas Family Code with respect to the medical treatment of minors. In the event that compliance with this provision would result in the state's loss of federal funds, the Department may modify or suspend this provision, only as allowed by law and as necessary to prevent such loss of funds, providing that the Governor and the Legislative Budget Board approve the modification before it is made." Rider 14 Background: Chapter 32 of the Texas Family Code specifies for which medical diagnoses and treatments a minor may consent on his/her own without parental involvement. Generally, these include those diseases and conditions for which the failure to seek diagnosis and treatment would be detrimental to the health of the minor, including drug/alcohol abuse, pregnancy, and sexually transmitted diseases. Although not specified in the language of Rider 14, Sen. Ogden's intent is most certainly directed toward the family planning program and the minors served by federal and state family planning funds. The family planning funds distributed by the Texas Department of Health (TDH) are almost totally federal monies from a variety of sources (Title X, Title XIX/Medicaid, Title V, Title XX and TANF). Two of these, Titles X and XIX, have strict, statutory guidelines which mandate confidential services for family planning services regardless of age. In addition, Title X is administered by the "total budget concept" which means that Title X regulations apply to all funding coming into a Title X program. Implementation of Rider 14 is an administrative nightmare for the Texas Department of Health and the family planning agencies with which they contract. Those programs with Title X funds must adhere to their regulations requiring them to provide confidential care for sexually active minors seeking services. Others who do not receive Title X funds will be able to provide confidential care to some patients (Title XIX/Medicaid), but not to others (Title XX, TANF or Title V). Two friends sitting in the same waiting room may be treated differently, depending on their income eligibility for services and/or their ability to pay for their own care. Parental consent may be required for one and not the other. Bad Public Health Policy: Without exception, public health and medical experts have supported confidential access to family planning services for minors. Organizations which are on record opposing mandatory parental involvement when a minor seeks family planning care include the following: The American Public Health Association The American Medical Association The American Academy of Pediatrics The American College of Obstetricians and Gynecologists The American Academy of Family Physicians The Society for Adolescent Medicine The American Nurses Association The National Association of Social Workers The National Education Association The American Psychiatric Association Clearly, Rider 14 is in conflict with established, sound, and recognized public health policies. Unfortunately, its implementation will have serious consequences for minors and adversely effect their health and well-being. Certainly, once the word is out, sexually active minors will choose not to seek services, leaving them at risk of unintended pregnancy and undiagnosed and untreated diseases and conditions. Rider 14 in Summary: Rider 14 creates a barrier to health care, and its implementation will result in increased teenage pregnancy and births, increased abortions, the spread of undiagnosed and untreated sexually transmitted diseases, including HIV; higher school drop-out rates; and increased infertility. The experts are not wrong! Their positions and those of their organizations are thoughtful, based on medical and social research, and in the best interests of minors and their health. Rider 15 Text: "Reporting Child Abuse. The Texas Department of Health may distribute or provide appropriated funds only to recipients which show good faith efforts to comply with all child abuse reporting guidelines and requirements set forth in Chapter 261 of the Family Code." Rider 15 Background: Although Sen. Ogden's target in pushing Rider 15 was once again the family planning provider agencies and the minors who seek care at their clinic sites, it also applies to a breadth of services programs funded by the Texas Department of Health. Some include WIC, HIV/AIDS and sexually transmitted diseases, Maternal and Child Health, Primary Care and Medicaid. Prior to the 1999 Legislative Session, health professionals were allowed to use their best professional judgement in determining which cases were abuse and needed to be reported. They took this responsibility seriously, and in many cases it was the health professional who identified and reported offenders to law enforcement. TDH has recently released their Rider 15 Implementation Plan. In an effort to avoid any public controversy, TDH developed a plan which requires that the agencies with which it contracts to complete a checklist on minors under age 14. TDH's contention is that it is illegal for anyone under age 14 to be sexually active although this is not apparent in statute. The litmus tests for sexual activity to be used by providers would be a positive pregnancy or sexually transmitted disease test. All these teens must be reported to law enforcement agencies or the Texas Department of Protective and Regulatory Services (TDPRS), if a parent, family member or guardian is involved. In addition, TDH has now stated that, if the files of older teens are pulled during rountine service audits, quality assurance staff will check to see if positive pregnancy tests or positive sexually transmitted disease tests in adolescents age 14-16 years of age are also reported. Bad Public Health Policy: Rider 15 is a classic example of bad public health policy. It creates a barrier to health care for the most vulnerable of teenagers, and eliminates the trust between the health care provider and his/her patients. Once the word is out, these teens will delay or avoid seeking care for suspected pregnancies or sexually transmitted diseases because they fear being reported to law enforcement agencies. They will be left at risk of unintended pregnancies, undiagnosed and untreated infections, and late or no prenatal care. The barrier to health care services created by Rider 15 for these vulnerable teens will also eliminate one of the best means of identifying and prosecuting true sex offenders. Recently a county sheriff called the director of a family planning program in the valley to thank her for her staff's help in apprehending a pedophile, noting that he would still be preying on children if her agency's had not reported the abuse to them. In addition, Rider 15 is discriminatory. It singles out TDH providers which primarily serve those who are poor and from minority populations. More affluent teens can seek and receive confidential care in the private sector, because their health care providers will not be monitored for compliance with the reporting requirements confidential of Rider 18. At best Rider 15 and TDH's plan of implementation represent discriminatory enforcement of state law and single out those who depend on subsidized care from non-profit community health facilities. A byproduct of Rider 15 may well be the labeling of some teens as sex offenders, a permanent status which forces them to register with the state and places their names on the internet, for simply engaging in consensual sexual relationships. Not only could this eliminate many career and licensure options for these teens, but by having their names listed on the Internet as a sex offender, could very well make them more vulnerable to predators. Neither TDPRS nor law enforcement agencies are prepared to handle the reports required by Rider 15 and TDH. They will simply flood an already overloaded system. Providers already experience difficulty in getting law enforcement and/or TDPRS to respond to abuse reports filed before the implementation of Rider 15. Currently, most law enforcement agencies are unaware of Rider 15 and the reports and the additional responsibilities it will generate for their offices and staffs. Certainly, it is likely that some of the worst of the abuse cases will be lost in the additional paperwork generated by Rider 15, allowing many predators, to escape arrest and prosecution, and to continue to prey on children. TDH's implementation plan, also, appears to be in conflict with statute. Chapter 32 Texas Family Code allows minors to consent on their own for the diagnosis and treatment of sexually transmitted diseases (STD). Yet, TDH is requiring that positive pregnancy and STD tests to be reported to law enforcement is in direct conflict with the Family Code provisions. Even teens who come to a clinic with a parent for a pregnancy test or other services will have to be reported, if they test positive for a STD or pregnancy. In Summary: As responsible health care providers, family planning agencies and their staff are concerned about child abuse and want to see those who prey on children and young teens arrested and prosecuted. They take very seriously their professional responsibilities to protect their clients and report cases of abuse. However, Rider 15 and TDH's plan for its implementation will create a barrier to health care for adolescent clients and overload law enforcement agencies and TDPRS, thereby allowing predators to go undetected and unreported. Rider 15 singles out for enforcement only those agencies and professionals who contract with TDH and serve the poor and largely minority populations.
Women’s
Health and Family Planning Association of Texas (WHFPT)
PO Box 3868, Austin TX, 78764, 512-448-4857 (voice), 512-448-3373 (fax), mail@whfpt.org. http://www.whfpt.org Web Sites for Real People.
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