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I have lived in Crystal Lake all my life. My entire family still lives in Crystal Lake, and I think I represent the values of the majority in McHenry County. Unlike other political issues, there was no room for compromise with the federal Title X funds. I believe, at least in this instance, the moral majority did prevail

. If the federal government continues to mandate that we keep parents in the dark, we will be happy to provide for our own without help from Title X funding. Thank you.

Mr. BILIRAKIS. Thank you, Mr. Heisler. Ms. Wuchner, last April, this subcommittee had a hearing on abstinence education. I was pleased to read in your testimony that Northern Kentucky Independent District Health Board stated an intention to focus on what we call character-based abstinence education, including parental communication. So I wonder if you can take maybe a couple minutes, give us an update on the status of such education in Northern Kentucky and what do you think of it? In other words, your opinion, how would you grade it?

Ms. WUCHNER. That change came about last year because of research into title V funding, just like we were doing this year in title X. And it revealed that some of the programs that we were currently providing for the schools did not meet the wise guidelines that Congress set forth in title V funding. And so we had a set up a screening tool to screen programs that would meet the guidelines and be appropriate for the values and the conditions of our community. One of the things I want to add is that when a public opinion poll was taken in Northern Kentucky by the press, it was three to one in favor of abstinence education. This is the voice of parents in our community. That led to then a lot of hard work to discover programs that would meet the factors in the screening tool, meet the guidelines, and we began doing that and chose a particular program that would now be available for this coming school year.

I would like to say that for quite some time the health department was not the most popular place to come for your ex education for your schools. There were public schools that used the programs but many that didn't. We just had a meeting and the report was that we need to add some staff. We may have more people than we ever anticipated, more schools signing up for programs this fall that support character-based abstinence education and a continuum and also the parents' communication and parents have been put into the program. So thank you.

Mr. BILIRAKIS. Thank you. Thank you very much. And the Chair now yields the balance of his time to Mr. Pitts.

Mr. PITTS. Thank you, Mr. Chairman. Mr. Chairman, I would like to submit for the record a letter to you from the Honorable Steven Ogden, a State Representative from Texas who wrote a parental consent law that was invalidated by the title X regulations.

Mr. BILIRAKIS. Without objection, that will be the case. [The letter referred to follows:]

July 11, 2002 The Honorable MICHAEL BILIRAKIS Chair, Subcommittee on Health Committee on Energy and Commerce U.S. House of Representatives 2125 Rayburn House Office Building Washington, DC 20515

DEAR CHAIRMAN BILIRAKIS: Over the past several sessions of the Texas Legislature, I have attempted to strengthen state law and practice to ensure parents and guardians are involved in their children's health care decisions.

Currently, Title X of the Public Health Services Act and Title XIX of the Social Security Act hamper my state's desire to preserve the traditional role of parents in raising their children.

In the state's appropriations bill for FY 2000-2001, I included a rider directing the Texas Department of Health (TDH) to distribute funds for medical, dental, psychological or surgical treatment provided to a minor only if consent to treatment were obtained according to Texas law (Chapter 32 of the Family Code). The rider was permitted to be waived if federal funds would be lost.

In an exchange of letters between TDH and the regional office of the U.S. Department of Health and Human Services in 1999, it was determined that Texas would lose federal funds if the rider were implemented. Nevertheless, I included a similar rider in the FY 2002-2003 appropriations bill.

I seek your assistance in amending current federal law and regulations to permit Texas to accept federal funds under Title X and Title XIX without having to ignore its sovereign laws. Sincerely,

STEPHEN E. OGDEN Attachments cc: The Honorable Joe Barton

Mr. Ed Perez, Texas Office of State and Federal Relations

Mr. Pitts. Thank you. Ms. Wuchner, if a doctor in your State's title X program decided that it was in the best of a girl, both physically and emotionally, to notify her parents that their daughter was receiving chemical contraception shots, was depressed, was sick with a venereal disease, what penalty would be levied against the title X clinic? Would your program lose Federal funding?

Ms. WUCHNER. I think it is the perception of the clinicians that they would lose the funding. Now, there has always been discussion to this point, but at this point no one ever exercises that right if there is a right to do that because of the fear of losing the funding of the program. When the board grappled with this decision on title X funding this year, it was the consensus that it was problematic, that clinicians could not make that decision, that they were bound by the structure of title X funding to provide services to minors without parent notification.

Mr. Pitts. Thank you. Dr. Jenkins, does the American Academy of Pediatrics support any laws requiring parental notification or parental consent before prescribing medications or performing surgeries?

Ms. JENKINS. Let me say that the American Academy of Pediatrics recognizes the right for adolescents to receive confidential care and the acknowledgment that under State statutes are what governs most of us in terms of what we can do in a practice situation. Again, the concept here seems to be prohibiting physicians from notifying parents, and I don't think that is the stand that most of us are engaged in at all. I think most of us in fact involve parents when we can with adolescents once they come and present issues of a sensitive nature, including issues related to reproductive health. And so this particular stand that we would support laws that prohibit physicians I don't think our interpretation of the laws are that physicians are prohibited from giving parents-engaging parents in the health care with their adolescents. I think the picture is that it is not in the adolescent's best interest to think that they will come in the office, they will see you, they will present an issue to you and then you will call their out of the context of their engagement in that visit. And I think those are the kinds of situations that in many of the bills about this communication is what people are trying to protect against. And that is the fear that you, out of the context of the relationship within the care, that you would then pick up the phone or do something else to notify a parent and not really work with the young person to help them share this information.

Mr. Pitts. Well, Dr. Jenkins, if I may interrupt, and my time has expired, does the academy support any laws requiring parental notification or parental consent? I mean you have indicated

Ms. JENKINS. You mean any laws related to what? To

Mr. PITTS. Before prescribing medications or performing surgeries?

Ms. JENKINS. I don't performing surgeries is part of that. I think the academy does not support laws that require parental consent for contraceptive care, for example, that require parental consent. But I think part of what your question was expands pretty far beyond that limitation.

Mr. PITTS. Well, I am not sure

Mr. BILIRAKIS. The title X regs say that they must not be disclosed, that receiving services must be held confidential and must not be disclosed. That is what it says.

Ms. JENKINS. But when they are saying, “must not,” are they saying under what kind of provision that that occurs? It seems to me that if in some of the pictures that have been-kind of cases that have been discussed here, that it does not preclude the physician from counseling the adolescent about involving their parents, okay?

Mr. BILIRAKIS. That is correct.

Ms. JENKINS. What it does is it says don't pick up the phone and call somebody. It seems to me that would be my interpretation under that situation. It does not say that you cannot work with the adolescent and engage them in a situation in which they would involve their parents.

Mr. BILIRAKIS. My time has long expired. Mrs. Capps.

Ms. CAPPS. Thank you. I will allow you, Dr. Jenkins, in a moment to return to this. But, first, Mr. Heisler, you gave an eloquent testimony to the case study, if you will, of your country and your involvement in it. And your reason for being here is because you say that you did not want to accept, as a county, Federal money when it had all the strings attached to it that it did. And you have refused title X funding which implements mandatory parental notification laws for your health care facilities within your jurisdiction there. But I wonder if you have noticed that two statistics have changed in that time. Apparently 25 percent more teenage births have occurred in your county and that the rate of chlamydia for people 20 years and younger has doubled whereas the surrounding counties these numbers have continued to go down.

Dr. Jenkins, I want to thank you for being here on behalf of the academy. The American Academy of Pediatrics has been really on the forefront of engaging, I believe, our families to become stronger, because it is through this kind of communication skill that you help to instill in adolescents that gives them the confidence to talk with their parents in sensitive areas that sometimes teenagers are shy or hesitant to do. I am thinking of my own experience as a mother and also working with teen parents to watch and bring my own kids into their pediatrician as kids and sat in the office with them, and then at a certain point to have the child be able to walk into the doctor's office alone and the kind of increased confidence that gave my own children to begin to formulate the questions that they could deal with directly with you and that I had the confidence of trusting you and your profession.

You are kind of here today representing all of these people within clinics and settings around the country who work with teenagers, not the easiest group necessarily to work with, particularly in the area of sexuality and especially perhaps in this country where we have many conflicting standards that impede upon a young person's mind and also recognizing, as the academy does, the variety of family, that there is not a word “family” that is uniform in this country today that you presume upon that as you see a patient come into see you within the context of their home life, which can be very, very varied. And so I want—I would like you to use this time to further get at for us what this confidential relationship is, why is it so scary to some of us, and how can we come to see it as something that can be positive and assist our young as they make very important and life-changing decisions?

Ms. JENKINS. Right. First of all, let me say it sounds like you had a wonderful pediatrician.

Ms. CAPPS. Yes, I did.
Ms. JENKINS. Okay.

Ms. CAPPS. I felt very fortunate to—more than one, actually, over the life long.

Ms. JENKINS. Is that right? Okay. Well, I think what you have painted as a parent is that developmental context, and that is just so important. I think very often when people deal with their teenagers evolving through adolescence and into adulthood, they don't understand that it is a process and that in that process there has to be a bit of letting go, a pulling back over time. And so what helps the adolescent really manage themselves more effectively as older adolescents and young adults is having the opportunity to work with their primary care giver around these issues or to go to other health professions and express these issues. So I think our role is to really work with them to do that. And I think many of us also do this outside of even our own practices. I work with a project in the District now that works with fifth graders and their parents around some of these issues, trying to improve parental communication but also help the young people be supported by their families and work with families about how to support young people through their adolescence. So, certainly, pediatricians are in their training programs taught these types of skills and practice them and believe in them very firmly.

Ms. CAPPS. Could we focus again for the remaining time on title X and the rare, I would hope rare, times when teenagers present themselves to you, to our clinics in the various communities without, with an absence, with a dysfunctional family, if you will, or a non-existent family, an incestuous family, whatever the--and it is not that rare. How then does the pediatrician respond?

Ms. JENKINS. I think the pediatrician very often will look for other adult support individuals. I think sometimes there is not support within the family, and we have talked about situations in which external people are engaged in some sexual abuse with adolescents, but the incest is not uncommon and situations in which someone in the household is having an inappropriate relationship with the child is not uncommon. And so many agencies also have a relationship in which they are able to get help for these young people in addition to just providing family planning services. I think sort of the sense that we have this isolated sort of take this pill, take this shot is really not the way people operate, and I think that we understand the context in which some of this occurs, and we do seek intervention for these young people, and we certainly report incidents according to State and local statutes.

Ms. CAPPs. Thank you very much.
Mr. BILIRAKIS. Thank you. Mr. Pitts for his own time.

Mr. PITTS. Thank you, Mr. Chairman. Mr. Heisler, your testimony was quite compelling. You said that the parents of the young girl who was raped sued the county. What happened in that lawsuit? Do you know if anyone besides the perpetrator was held liable for keeping the parents in the dark after this awful victimization had gone on for 18 months? And also you said the Title X Office said essentially, “Keep the parents in the dark or don't take the title X money?” Did you ever hear from the office again when you made national news for rejecting title X money? Did anyone from the Title X Office call and say, "Hey, let us work something out”?

Mr. HEISLER. Thank you, Congressman. Frankly, with regard to the suit that the parents brought against the county, I do know that the county was dismissed out of the suit. I believe the principal at the grade school where this teacher taught was dismissed out of the suit. Beyond that I don't know what happened with it. Now, with respect to any further contact from the Title X people, we have had none.

Mr. PITTS. Do you think that other concerned citizens should ask their counties to follow your lead in breaking away or do you think the Federal agency that runs title X should reexamine the regulations that they have?

Mr. HEISLER. Oh, absolutely. I mean I might respond to that by saying I don't know the reason why Congresswoman Capps made that comment to me regarding the increase in teen pregnancy in McHenry County, but I can tell her that we have had a 100 percent decrease in teachers raping kids in McHenry County. It doesn't happen anymore. Parents know about it.

Mr. PITTS. Thank you. Dr. Jenkins, studies have reported that children are reaching puberty at very early ages, even as early as 9 years old. In your professional opinion, should a title X clinic be handing our or injecting a 9-year-old girl with prescription contra

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