There is a new battleground in the fight over teen pregnancy, comprehensive sex ed, and birth control: Gloucester, Mass. Already, the fight has led to the resignations of the top doctor and chief nurse at the Gloucester High School health clinic.
The situation is complex. In a nutshell, a local hospital, Addison Gilbert Hospital, (part of Northeast Hospital Corporation) administers a State Department of Public Health grant that enables the high school to have a health clinic. An advisory board, including a representative of the hospital, governs the clinic’s policies.
This year, Gloucester has been facing a wave of teen pregnancies (up from an average of about 4 a year to 17 so far this year), and the head doc and head nurse want the clinic to consider providing confidential contraception — birth control — as one part of a larger strategy to reduce teen pregnancies. Lots of other school-based health centers already do this. The hospital rep said no way. Now Gloucester’s superintendent is looking into shifting the grant away from Addison Hospital.
Contraception works. Questions: Will the superintendent continue to rise to the challenge? (He seems to be doing well so far). Will the Department of Public Health back him up? Will Addison Hospital do the right thing and reverse course?
if they don’t, then Gloucester is well within its rights to seek a new partner with their grant. Kudos, also, to the Super. I’m glad to see him show a little courage: contraception should be something available at any high school. Wishing problems away hasn’t proven very effective; at least, we should provide tools to our kids so that they won’t end up pregnant or with preventable STDs.
Did it ever cross anyones mind that perhaps these woman wanted to become pregnant. I mean they have that right. They have the right to have sex, have sexual intercourse resulting in pregnancy, and the right to carry a pregnancy to full term and give birth. They also have the right to WIC, financial assistance, medical assistance—-all at no cost. They also have the right to multiple abortions or births all at taxpayer expense. What’s the big deal. 17 pregnencies in the grand scheme of things is nothing. What’s the worst the that could happen? They will all be thriving, loving families.
<
p>Lighten up.
it’s not a contraceptive issue…it’s a consent issue. It would be great if every 18 year old having sex with 13 and 14 year old girls would have the sense to use a condom. it would be better if 13 and 14 year old girls wouldn’t be hanging out with 17 and 18 year old boys who wanted to use them for sex… (and then were no where to be found when the pregnancy test came back positive)…Sure it would be better but today casual, unprotected sex is the norm not the exception in high schools across the Commonwealth….not just Cape Ann…and teen pregnancy is on the rise with younger and younger girls.
<
p>But, there are several reasons why only 25% of the school based health clinics give out contraceptives to minors and it’s called parental consent and medical liability. Parents sign their children (dare I use the word “children” here)..they sign up for the health services at the school clinic BUT that does not include giving their permission for the clinic to give out oral contraceptives to their child without their knowledge or consent.
<
p>In Gloucester’s case, the School Committee acts on behalf of the parents in considering what kind of health care clinic will be run. The School Committee has not acted on this issue. When it does, it will have to consider not just parental rights but also issues of liability if and when something goes wrong.
<
p>The Gloucester school clinic is not open during the summer. Who takes responsibility for the child on oral contraceptives then? Does this Doctor open his practice doors to care for children on contraceptives unbeknownst to their parents? Does his malpractice insurance cover these visits or is the School Department responsible for permitting the distribution of oral contraceptive drugs in the first place?
<
p>Seems like an easy issue on the face of it. They are having sex, getting pregnant. Can’t stop the sex so give them the drugs to stop the pregnancies. Easy!…BUT there is more to it than that…Addison Gilbert Hospital has to face the not-so-cut-and-dry facts of the matter. So before we pillory them, let’s get the facts and answer the pertinent questions that need answering before moving forward on such a plan… see what the School Committee and parents have to say.
<
p>And while we are talking about parents rights…lets talk about parents responsibilities, too. We can’t turn every problem over to schools to solve, but if that’s what we intend to do, we had better be very careful how we do it.
Father of a GHS student, husband of a GHS teacher, so I know a little about the situation here.
<
p>The doctor involved, Dr. Brian Orr, is a well-known and very well respected member of the Gloucester community. (Disclosure: he’s also my son’s pediatrician). He’s been central to many community health efforts and is a published author (books and a newspaper column) on children’s health issues. So this is a doctor who knows his stuff and will be supported by the community.
<
p>The current “confidential contraception” outlet for kids is located in Beverly, which is not only a distance barrier for many people in Gloucester, it’s also a mental barrier. Beverly may as well be on a different planet at times, given our insular local mentality. Going “up the line” for services like this is not a realistic option.
<
p>The hospital corporation and the community have a very awkward relationship. Ever since Northeast bought AGH, there’s been suspicion of the “out-of-town” folks running “our” hospital, and the Northeast leadership has frankly been terrible on communications issues. Very few people on Cape Ann trust anyone from Northeast, because they haven’t earned that trust.
<
p>No one that I’ve talked to in the community has any good idea for why this was such an extreme year for teenage pregnancy. My sense is that the young men and young women involved present the standard list of reasons for becoming pregnant, from poor knowledge about contraception to “wanting a baby” to just plain bad luck. This wasn’t an epidemic of intent, just of results. The oddest thing to me was that this was happening with younger women; from what I understand, none of the high school students was a senior, but all sophomores and juniors.
<
p>As far as the community is concerned, I hope that this is something that we can unite about. Gloucester is a community that in many ways is willing to acknowledge mistakes (we’ve got a significant alcoholism problem) and then seek to prevent our kids from making the same mistakes. Clearly this is a place we can talk about making changes, with or without the help of the hospital company.
Patrick, thanks for your perspective on this news story.
<
p>Truth be told, every community that ever at one time had a “community hospital” feels ambivalent to the larger health care entity that takes over the local facility. I think Gloucester lucked out when Northeast made a commitment to keep the Addison-Gilbert Hospital open and available for you. (They could just as easily have saved an enormous amount by closing it down as community hospitals in Woburn and Arlington and dozens of other towns in my area were)…file that under no-good-deed-goes-unpunished…
<
p>That Northeast has stepped up to also run a school based health clinic is to be praised. I am sure the clinic offers many services needed by the students. The oral contraceptive issue focuses on just one of those services being considered. I think it is up to the School Committee to consider all aspects of this and answer concerns as to the need for clarification on the parental notification and liability issues. It’s their job, not the hospital’s, to make that policy.
<
p>I don’t think anyone is doubting that your child’s pediatrician is familiar with the teen pregnancy problem and is respected by the community. But, I think rather thatn grandstanding with public resignation, he would have done more to help solve the problem by taking his case for confidential birth control dissemination to minors before the School Committee. They need to make the decision before the hospital can move forward.
<
p>It’s too bad because this doctor has paved the way to making it a political football…next thing you know every local politician will be weighing in…
is framing this in an entirely different light. The right is saying the school wants to give drugs to your minor child without parental knowledge or consent. They don’t mention birth control it is just the issue of giving drugs to your minor child. Since I am with the anti-globalist party I take this as manufacturing political debates for the purpose of keeping people stupid, angry and divided.
Would a fifteen year old know if the family has a history of developing clots due to estrogen?
<
p>Would a sixteen year old know that if you have an IUD, you can’t have a MRI scan?
<
p>If they can’t communicate these things to parents – might this not make for a disaster in a medical emergency, when a doctor needs to know all medications, but is talking to the parents only?
<
p>I’m surprised any hospital gives medications to minors without parental consent – they won’t put stitches in a cut or perform a tonsillectomy, but they’ll prescribe medications with known side effects?
… these things at 16, how much more likely are they to know them at 18?
<
p>Age is no barrier to ignorance.
…and the ignorant parents consent to an MRI because they don’t KNOW she has an IUD – and the copper heats up and causing permanent scarring – are they ignorant, or just aged?
The point is that age isn’t a criteria that changes the situation. Are you seriously arguing that in your example it is helpful for the parents to be informed so it should be the law? Why not 18 year olds then? They certainly also get into auto accidents, after all. Their parents could certainly also not know about an IUD.
A sixteen year old is routinely treated based on medical info supplied by parents.
<
p>And lying on a table with a broken leg isn’t the best time to begin a discussion, “mom..dad…” Whereas, an 18 yr. old has Mom and Dad swept from the room during medical interviews.
… an unconscious accident victim.
<
p>I’d hope that if IUDs w/ MRIs are deadly, that doctors would know to ask. I would further hope that they understand that the parents are not always the best source of sexual history knowledge.
…although ‘deadly’ is overdramatic. Still, a pin in the leg, an old silver post, an IUD – anything with metal – heats up and burns the surrounding tissue. I woud say that a ‘normal’, asexual metallic installation WOULD be known by the parents.
<
p>And I would submit that the first hospital that was accidently made party to the unplanned potential sterilization of a minor would have a huge lawsuit on its hands, with the insurers going after the sponsor of the school program for subrogation.
<
p>Which is why this isn’t just a cut-and-dried thing.
“And I would submit that the first hospital that was accidentally made party to the unplanned potential sterilization of a minor would have a huge lawsuit on its hands.”
<
p>That’s another reason I think doctors would find a way to ask.
they probably do screening x-rays first, which should detect metal in the body of an unconscious person.
“Do you have an adverse reaction to any medication?” “Huh?” “Do any pills make you sick?”
“Huh?” We call it Veterinary medicine. A horse can’t respond. You just give it your best shot.
<
p>I would sooner shoot myself in the foot that give any med to any person, of any age, without written informed consent.
And a teen who may not fully aware of family medical history is not ignorant, but perhaps those who expect them to be, are.
Please correct me if I’m mistaken, but as far as I know the sex-ed curriculum of GHS isn’t the issue and “abstinence-only” has nothing to do with this controversy. The diarist doesn’t even mention the crux of the issue (touched on by the comments) – prescription birth control meds are being prescribed to minors without parental consent.
<
p>I don’t know why Lasthorseman calls this a “conservative framing” of the issue. I am a liberal and proud of it, but as a parent of two 20-somethings, I can’t imagine how any agency could have been allowed to prescribe any medication to my minor children without my knowledge.
<
p>I have no objection to comprehensive sex education, in fact I believe it should be compulsory no matter what the parents have to say. Nor do I have an objection to condoms being freely distributed without question in any health clinic including school nurses’ offices. But prescription meds (or invasive procedures like IUD insertions – is this really an issue, PP?) for minors shouldn’t be allowed without parental knowledge and consent.
I’m guessing that by “prescription meds” people mean birth control pills. i completely support the right of a young woman to get birth control pills without her parents knowledge. sometimes it is the sperm of a family member that needs thwarting. not all children come from loving homes and are able to trust adults around these issues.
Do I read this right? If a child is suffering from sexual abuse from a family member then they need birth control pills? Sounds like the child needs a lot more than that.
<
p>Birth control pills won’t solve this issue.
however, you are living in a dream world if you think they will necessarily get it. not every child has an AmberPaw waiting to help release them from the terror of their lives.
that you’re essentially raising a non-sequitor. Whether birth control is offered without parental consent or not is immaterial to the situation you describe. So your hypothetical case, tragic as it is, isn’t relevant here.
you raised an objection to under-aged people being given prescriptions without parental consent. i raised a perfectly reasonable and real situation where i think it is justifiable. you can disagree, it is not a non-sequitor. the whole diary is about birth control and under-aged people, is it not?
in the case you cite, birth control is NOT the solution, and to my mind does little to improve the situation, and may even imply consent to some (sick) minds.
“put yourself in her shoes”. no, birth control will not remove a young woman from an abusive situation, but it can prevent her from becoming forcibly pregnant. what will it take to convince you that not all young women in this situation can get out in a timely fashion? talk to any school councilor or social worker – this happens. don’t forget that abusers have mental sway over those they abuse, not just physical. why not give the young woman access to protection from pregnancy until she can get away from her raping daddy/uncle/brother/grandpa/step father/mommie’s boyfriend/neighbor? how can you in good conscience insist on your way when then alternative is forced pregnancy? why prevent such a young women from having control over the one thing in her life that she can control – fertility?
Not being female, it would take a lot of hubris for me to think I could do that. And yes, I know that the situation you pose does indeed take place. What I can’t really understand is how having control over her fertility helps things. Are there any studies, or any literature that shows that simply getting birth control confers any benefit?
<
p>Another thing I can’t understand is how this girl can receive birth control pills without some kind of interview taking place between the girl and a health professional, and not betraying any of the situation. And if the situation is betrayed, isn’t the health professional a mandated reporter? Does patient confidentiality trump the reporting duty if the patient is a minor?
is not taking a young women’s word for it, and instead imposing your “humble” imperatives on her.
<
p>the patient probably won’t tell the doctor that she is being raped by dad. she’s too scared dad will kill her. or worse yet, kill mom. teh doctor can fish for information, but ultimately is presented with the decision whether or not to give a prescription for birth control pills to a young woman who admits having sexual activity (type and circumstances withheld from the doctor).
Progressives will indemnify me—-OK—no problem then.
at which a child can make medical decisions without parental consent?
<
p>Seems to me like the issue is birth control pills because that is the prescription med proposed to be administered w/o consent. People would have the same justified reaction if someone was proposing to put their kids on Ritalin without consent.
because in the scenario i outlined, birth control is protecting the young women against forced impregnation by others. afaik, ritalin provides no defense against violation of one’s body by another person.
Your abusive parent is a non-sequitor. If you’re trying to protect an individual from rape, then there are ways to do this that (i) may actually protect the individual from rape and (ii) do not deprive all parents of their consent right when it comes to the medical treatment of their minor children.
<
p>And, again, how young is old enough for this to be a reasonable rationale? 10? 11? Puberty?
i said it protected agaisnt a consequence of rape: forced impregnation.
<
p>how old? that is a medical decision. but as we are trying to stop unwanted pregnancies, wouldn’t around puberty make sense?
<
p>do you honestly think that a raping parent deserves the right to refuse consent for the child’s birth control when it comes to protecting the child they are brutalizing from forced pregnancy? do you see how ridiculous your logic is? truly amazing. sickening, actually.
The remedy for abusive parenting is to remove a child from the parent’s care, and to revoke parental rights over matters such as this. Not to try to make a minor into a non-minor. And certainly not to revoke all parents’ rights because some tiny fraction of them are abusive.
<
p>The issue is that a school seems to be deciding that it can give prescription medication to minor children without parental consent or knowledge, which is outrageous.
you can’t remove a kid from an abusive situation if you don’t know the situation exists. out of fear and shame, kids often hide the fact that they are being abused. the legion priest rape cases that never came to light until the victims reached adulthood should have taught this if nothing else.
I used to work in a professional office in a city adjoining Boston. Small office. The other person who worked there was ‘Jane’, a 30-something ethnic Catholic with a young daughter in parochial school. Jane had a niece, Frances. Sixteen yr. old Frances used to come in after school and do filing, other office chores.
<
p>Frances gets pregnant with her boyfriend, Fred. Goes to local women’s group, who accompany her to court. She gets a court order for an abortion to be allowed, based on ‘family situation’ as Frances told it. Frances was being raised by her divorced mother, there were no inappropriate males around. Frances just didn’t want to get yelled at. In fact, the religious background of the family was used as evidence to obtain the court order.
<
p>Jane is in a quandary. She agrees to accompany Frances to the abortion, thinking it will be a teachable moment. Much heart to heart discussion, etc., with her sister’s child – and she agrees to keep the secret if Frances will use birth control. Procedure performed, penitence all around. Jane monitored the follow up, and the recuperation, telling her sister that Frances must have the flu.
<
p>Flash forward six months. Frances is pregnant again. Thought the birth control made her fat, so stopped. Goes to same group, gets permission for another abortion. This time, Jane refuses to accompany her, saying that she had betrayed her personal principles once for an exceptional circumstance, but would not do so again. Frances has Freddy take her to the hospital. Blows off antibiotics, recuperation, winds up in emergency room, telling her mother that the kids at school have strep throat.
<
p>Mother, sitting with Jane outside examination room, asks, “What’s going on? Why are gynecologists there for a strep throat?” She had no idea that her sixteen year old had already had two abortions. Frances will now never have a child, due to complications from infection.
<
p>I was and am pro-choice for adult women. But for minor girls – no. And before you raise the specter of incest, etc., if that is going on, then the girl needs to be removed from the home, not merely protected from pregnancy due to unspeakable behavior.
First, what did this incident make you change your mind about?
<
p>Second –
<
p>Are you saying the state should force minor children to carry their pregnancies to term? Or that abortions should not be available to minors without parental consent?
<
p>Pregnancy due to incest is a tough case. You say the girl needs to removed from the home, but what if it’s not a case of someone in the home causing the pregnancy. Say, rape by an uncle, which the girl is too embarrassed to admit to her parents. In this case, I’d still want to require parental consent.
My attitude had been similar to Laurel’s, thinking that rape/incest were the only exceptions made by the courts. I learned that MANY such exceptions are made, from both ‘Frances’ and other young women.
<
p>It forced me back to my original pro-choice stance – that sexual treatment and pregnancy shouldn’t be treated any differently than other medical condidtions, and should only be regulated for sanitation and safety, not right or wrong. So, if other medical procedures aren’t performed without parental consent – then neither should abortion or contraception.
<
p>And no, of course I don’t want a young girl to be forced to bear a child – not what I meant at all.
<
p>It also made me look more kindly on’Women’s Right to Know’ bills, which require information be given about gestational stages, viability, etc. Because if Frances had learned that when she had her first abortion – maybe there wouldn’t have been a second.
is the art of making sure no one is happy. Something I’ve thought isn’t an awful idea is a parental notification law. A daughter must notify the parent regarding medication, abortion, surgery, etc., but the parent does not have the right to refuse the treatment. I know it’s a half-measure on both sides, but as someone who is conflicted between the two sides, it seems like the most workable solution.
It takes away the right of parental consent to treatment of their minor child. It doesn’t help the child who is in fear of parental reprisals.
…a school should not be either the location of a health clinic or a facilitator of new treatments/medication not directly related to school. A school nurse is there to treat injuries and symptoms of illness that arise IN SCHOOL, as well as administering previously-prescribed medication that has to be taken during school hours. I’m willing to allow for judicial review in extenuating circumstances (abuse, religion, etc), but generally speaking I believe the medical issues of a minor are the provence of custodial parents/guardians.
<
p>I believe education is the key to prevention. I believe in teaching the truth which only leads to the conclusion that abstinence is in fact the absolute fool-proof way to avoid getting pregnant or an STD. To be clear though, there is a difference between teaching abstinence, which I favor, and preaching it which is what the religious right seems to want. By all means teach the reproductive system and how to manipulate it just as you would any other system of the human body, but don’t facilitate experimentation.
If the school engages in any conduct to dispense, aid or abet the dispensing of a prescribed medication to any minor female, it would seem to me that they are conspiring, aiding and and abetting in the commission of a felony to whit: rape. The expected outcome of dispensing birth control to a minor would lead a reasonable and prudent person to assume that that person would engage in sexual intercourse and that sexual intercourse being unlawful, aforementioned person are now guilty of a crime. And—if such conduct is not brought before a grand jury, it would not seem unreasonable that aforesaid school system and such persons employed by that school system be held civily liable for all damages resulting from the failure of such person to use aforementioned medication with due diligence and any adverse outcome from an act of omission or commission would also result in peril for aforementioned school district and all such various persons employed by such school system.
<
p>Point: Give all the birth control you want–but if something goes wrong—I’m going to sue you each and individually for every penny you will ever have.
your disapproval will not prevent kids from having sex, and never has. do you think teen pregnancy is a new thing? lol! you see “tacit approval”. i see “recognizing reality”.
It’s a simplistic response, but essentially the heart if the issue. I think what Pete was driving at—please excuse me sticking my nose in here—-is that the school could be held liable and criminally responsible for any adverse outcome for any act of omssion or commssion vis a vis a student (minor or otherwise)while that student is in the care and custody of the school.
This is all post the hippie –dippie generation. We brought this on ourselves and we continue to slide south.
<
p>now I am also a realist—-so to keep the engine of Planned Parenthood well oiled—lets set up weekly abortion clinics at our local high schools and junior high schools (Walk In) On Frdays to failitate recover. Then on Mondays we can offer STD climics. We all know the kiddies are going to have sex anyway and they will continue to spread all of the popular STD’s so having walk in STD clinics is not a bad idea either. Of course we can circumvent mom and dad knowing the Mary of Joe are getting an IM or PO antibiotic. It’s not like we are talking about Ritalin or anything like that. I mean—-antibiotics are like birth control—they are for the kids own good.
<
p>I wonder if an IUD clinic is also called for?