vate and privileged relationship with the provider. Additionally, they should be informed of any restrictions on the confidential nature of that relationship."

The American Academy of Family Physicians. "The American Academy of Family Physicians supports the appropriateness of parental involvement in medical decision-making for adolescents, especially when they are engaging in precarious or adult behaviors. Whenever possible, family physicians make an effort to facilitate parental contact to help bridge any communication challenges that may arise between parent and child."

The Society for Adolescent Medicine. “The most practical reason for clinicians to grant confidentiality to adolescent patients is to facilitate accurate diagnosis and appropriate treatment... If an assurance of confidentiality is not extended, this may create an obstacle to care since that adolescent may withhold information, delay entry into care, or refuse care.'

The American Medical Association. "The AMA reaffirms that confidential care for adolescents is critical to improving their health. The AMA encourages physicians to involve parents in the medical care of the adolescent patient, when it would be in the best interest of the adolescent. When in the opinion of the physician parental involvement would not be beneficial, parental consent or notification should not be a barrier to care.

American College of Physicians-American Society of Internal Medicine. "Physicians should be knowledgeable about state laws governing the rights of adolescent patients to confidentiality and the adolescent's legal right to consent to treatment. The physician must not release information without the patient's consent unless required by the law or if there is a duty to warn another."

The American Public Health Association. APHA "urges that...confidential health services (be) tailored to the needs of adolescents, including sexually active adolescents, adolescents considering sexual intercourse, and those seeking information, counseling, or services related to preventing, continuing or terminating a pregnancy."

CONCLUSION

In conclusion, as a physician, a teacher, and most of all, as a parent, who is concerned about the quality and safety of health care for my daughter as well as for the quality and safety of health care for all adolescents in this country, I urge you to reject attempts to restrict adolescents' access to confidential health care services, including prescription drugs or devices.

Thank-you. I would be happy to answer any questions you may have.

Mr. BILIRAKIS. Thank you very much, Dr. Jenkins.
Mr. Heisler.

STATEMENT OF JOHN A. HEISLER

Mr. HEISLER. Mr. Chairman and members of the committee, I want to thank you for the opportunity to come before you and explain why McHenry County, Illinois refuses to take Federal funding that requires us to provide contraceptive services to minor without parental notification.

Our county was forced to deal with an issue of parental notification when we found out that a 12-year-old junior high student was getting chemical contraceptive shots because her 37-year-old teacher was raping her. The McHenry County Board of Health administers a $4 million budget and generally-should I continue?

Mr. BILIRAKIS. Yes, please continue. That is a message to us regarding what is happening on the floor.

Mr. HEISLER. The Department of Health has three divisions: Animal Control, Environmental and Nursing. About 75 percent of the revenues of the health department are derived from grants. In the past, grants were sought out and applied for by senior staff within the department. Grant applications are formally submitted to State and Federal Government over the signature of the health department administrator. Since my county's rejection of the title X grant, all new grant applications and all grant renewals in excess

of $50,000 are submitted to the county board for approval prior to being submitted to the grantor.

The McHenry County Board of Health was created by resolution of the county board, not by referendum. While State statute in Illinois does extend a great deal of authority to the board of health, the ultimate authority comes from the county board who approves its budget and appoints its members.

The title X debate in McHenry County began in January 1997 when it was learned that a 12- or 13-year-old school girl had been driven to the county health department clinic on several occasions by her 37-year-old Crystal Lake Middle School teacher who had been having sexual relations with her for some 18 months to receive injections of the contraceptive drug, Depo-Provera. Unfortunately, Federal title X regulations prevented her parents from being informed.

Her teacher, William Saturday, pleaded guilty to criminal sexual assault charges in September 1997 and was sentenced to 10 years in prison. According to public record, Mr. Saturday was released in February of this year after serving less than half of his sentence. He is currently on parole and living in McHenry County as a registered sex offender.

This teacher could not take or send a 12-year-old girl to his school nurse. He could not take her to a private doctor or physician. He could only take her to a title X program facility where no parental consent was allowed. The title X grant aided him in his crime. In Illinois we protect our children under various State statutes. A minor cannot buy a pack of cigarettes, a drink or even get a tattoo in Illinois because of the potential danger. Furthermore, the school code of the State of Illinois prohibits the administration of any drug or medical attention without parental consent. It is shocking to think that a Federal grant program can circumvent our State code.

As a member of the board of health, the Health Department Oversight Committee and the county board, I began to inquire about the no-parental notification clause of title X. I was not made apparent of the executive review and the executive review of the grant. Hearing no acceptable answers, I asked the health department administrator to check with the Federal Government, and he was told that there would be no exceptions and further that we had to accept the title X grant with the no-parental notification provision or reject it in its entirety. I would like to repeat that. The Federal agency that administers title X essentially gave the parents in McHenry County two options: Take the title X money and be kept in the dark about your kids or reject the money. Ultimately McHenry County did, in fact, reject title X funding.

At the regular county board meeting of October 1997, I made the motion to remove the approximately $47,800 in title X funds from the county budget. In addition, as finance chairman, I restored the gynecological services to poor adult women to the budget from local tax dollars. The message was sent back to Washington, "We cannot be bought. We will not accept your money if it affects our children. We feel it is the parents' right to determine if any child needs medical services. A child in McHenry County cannot be given even an aspirin from the school nurse without parental consent. The board

of health in McHenry County will not circumvent the basic rights of parents by accepting Federal title X funds."

McHenry County has not applied for title X funds since this time. We do not provide contraceptive services to minors without parental consent. We have allocated tax dollars for pre-natal care and all other related gynecological services to that segment of our population that cannot afford medical services or insurance. As with all of our nursing services, we target recipients who do not qualify for Medicaid or have sufficient income to afford medical in

surance.

The debate over the title X grant in McHenry County was stifled by a gag order due to the lawsuits brought against the county by the girl's parents. Elected officials, board members and employees were asked not to discuss the issue as it might have had a detrimental effect on the defense of the county's position.

Mr. BILIRAKIS. Please summarize, Mr. Heisler.

Mr. HEISLER. 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.

[The prepared statement of John A. Heisler follows:]

PREPARED STATEMENT OF JOHN A. HEISLER

Mr. Chairman and Members of the Committee, I want to thank you for the opportunity to come before you and explain why McHenry County, Illinois refuses to take federal funding that requires us to provide contraceptive services to minors without parental notification. Our County was forced to deal with the issue of parental notification when we found out that a 12-year-old junior high school student was getting chemical contraceptive shots because her 37-year-old teacher was raping her. Background:

McHenry County is about 50 miles northwest of Chicago, Illinois. Population is approximately 280,000. McHenry County is the fastest growing county in the State of Illinois.

The County Board is a 24-member board, made up of four elected representatives from each of the six districts within the County.

I have been a member of the County Board since August 1994. I am a member of the Public Health Committee, the Valley Hi Nursing Home Committee and Chairman of the County's Finance Committee. McHenry County has an annual budget of about $130 million and has approximately 1,200 employees including a sheriff's department of 300 officers.

Throughout the County, we have several organizations that are supported by the County budget. These organizations have their own Boards whose members are appointed by the County Board, and each has a "Liaison" member from the County Board with voting privileges. These “Liaison” members are on these Boards to give some fiscal guidance and to promote the general philosophy of the full County Board.

In the fall of 1994, I was appointed Liaison Member of the McHenry County's Board of Health. The McHenry County Board of Health had eight members (now nine) consisting of two physicians, a dentist, a civil engineer, a nurse, two citizens from the County and the County Board Liaison.

The McHenry County Board of Health administers a $4 million budget and generally sets the policies and standards of conduct for a staff of 100. The Department of Health has three divisions: animal control, environmental, and nursing. About 75% of the revenues of the Health Department are derived from grants. In the past, grants were sought out and applied for by senior staff within the Department. Grant applications are formally submitted to the State or Federal Government over the

signature of the Health Department Administrator. Since the County's rejection of the Title X grant, all new grant applications, and all grant renewals in excess of $50,000 are submitted to the County Board for approval prior to being submitted

to the grantor.

The McHenry County Board of Health was created by Resolution of the County Board, not by referendum. While State Statute does extend a great deal of authority to the Board of Health, the ultimate authority comes from the County Board who approves its budget and appoints its members.

Title X:

The Title X debate in McHenry County began in January 1997, when it was learned that a 12-year-old grade school girl had been driven to the County Health Department Clinic on several occasions by a 37-year-old Crystal Lake Middle School teacher who had been having sexual relations with her for 18 months, to receive injections of the contraceptive drug Depo-Provera. Unfortunately, federal Title X regulations prevented her parents from being informed.

Her teacher, William Saturday, pleaded guilty to criminal sexual assault charges in September 1997, and was sentenced to 10 years in prison. According to public records, William Saturday was released in February of this year-after serving less than half of his sentence and he is currently on parole and living in McHenry County as a registered sex offender.

This teacher could not take or send the 12-year-old girl to the school nurse. He could not take her to a private doctor or physician. He could only take her to a Title X program facility where no parental consent was allowed. The Title X grant aided him in his crime.

In Illinois we protect our children under various state statutes. A minor cannot by law buy a cigarette, a drink, or even get a tattoo in Illinois because of the potential danger.

Furthermore, the school code of the state of Illinois prohibits the administration of any drug or medical attention without parental consent. It is shocking to think that a federal grant program can circumvent our state code.

As a member of the Board of Health, the Health Department Oversight Committee (Public Health Committee) and the County Board, I began to inquire as to why the "no-parental notification clause" of Title X was not made apparent in the executive review of the grant. Hearing no acceptable answer, I asked the County Health Department Administrator to check with the Federal Government, and he was told that there would be no exceptions and further that we had to accept the Title X grant with the "no-parental notification" provision, or reject it in its entirety. I'd like to repeat that: The federal agency that administers Title X essentially gave the parents in McHenry County two options: 1) take Title X money and be kept in the dark about your kids or 2) reject the money.

Ultimately, McHenry County did, in fact, reject Title X funding. At the regular County Board meeting of October 1997, I made the motion to remove the approximately $47,800 in Title X funds from the County's Budget. In addition, as Finance Chairman, I restored all gynecological services to poor adult women to the budget from local tax dollars. The message sent back to Washington was: We can't be bought. We will not accept your money if it affects our children. We feel it is the parents' right to determine if any child needs medical services. A child in McHenry County cannot be given even an aspirin from the school nurse without parental consent. The Board of Health in McHenry County will not circumvent the basic rights of parents by accepting federal Title X funds.

McHenry County has not applied for Title X funds since this time. We do not provide contraceptive services to minors without parental consent. We have allocated tax dollars for pre-natal care and all other related gynecological services to that segment of our population that cannot afford medical services or insurance. As with all of our nursing services, we target recipients who do not qualify for Medicaid or have sufficient income to afford medical insurance.

The Debate:

The debate over the Title X grant in McHenry County was stifled by a gag order due to the lawsuits brought against the County by the girl's parents. Elected officials, Board Members, and employees were asked not to discuss the issue as it might have had a detrimental effect on the defense of the County's position. The vocal minority in the community was not under any such restriction. As a result, the public debate was very one sided. Proponents of Title X organized into a group called "Friends of Public Health" and attacked me at home, at work, at church and at Board meetings. Under the gag order, I was not permitted to reply or respond.

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:]