ceptive drugs? Do you think a 9-year-old should be making medical decisions without her parents' input?

Ms. JENKINS. I know you don't think I am going to say yes. First of all, I think when people talk about the studies you are talking about with puberty, they mean appearance of breast buds, which is the onset of puberty. They do not mean, for example, full reproductive maturity. So I think we should be clear about we are talking about when we read those studies about early puberal maturation.

It is my opinion that most responsible health professionals recognize that adolescents of a certain chronologic age who have behaviors that perhaps are in the adult range do not necessarily have decisionmaking skills that are in that range, and take the appropriate stances in terms of intervention of some sort, either to try to understand what is the context of that relationship and to seek intervention for a young person.

For example, I work in the inner city here in the District, and the anecdotal evidence is that approximately mid-teens is a time when you get adolescents who are reporting sometimes certain sexual behaviors. But when you have young people who are below those ages who come to you with any evidence and very often they are not reporting it, it is what you find on examination that suggests, for example, that something is occurring, that you take the appropriate intervention. And most often that is to engage a social service individual into investigating what the situation is for that young person. But I don't think

Mr. PITTS. But you are aware that the title X regs say that services without regard to age, you know, religion, race, color, national origin, age have to be provided.

Ms. JENKINS. If services are provided, I don't think it probably says specifically that you have to inject or give someone a contraceptive if you think that is inappropriate for what has happened to that young person.

Mr. PITTS. Well, suppose a 12-year-old girl walks into the title X clinic, don't you think someone should be calling the authorities or her parents? Isn't having sexual relations with a 12-year-old statutory rape, as we heard in this case, 12-, 13-year-old? But do you agree that to comply with Federal law, title X clinics should be reporting the fact that these minors are coming in for contraception?

Ms. JENKINS. I think, as far as I am aware, that the reporting of statutory rape is determined by the jurisdiction, and in the District, for example, there are guidelines around the age for reporting statutory rape and also child abuse. As far as I am aware, those statutes do not necessarily say that the first step is to call a parent up for notification. The first step is to engage the appropriate authorities.

Mr. PITTS. Would you limit the number of times per month, for instance, that a minor girl could get drugs? For instance, there is no limit now for a teenager going in for the "morning after" pill. Mr. BILIRAKIS. Just a very brief answer to that, please, if you

can.

Ms. JENKINS. I think that is a question sort of taken out of context, and so I

Mr. BILIRAKIS. Do you want an answer to your question. The doctor seems to feel it is taken out of context.

Mr. PITTS. Go ahead. You may proceed.

Mr. BILIRAKIS. Go ahead.

Ms. JENKINS. Okay. My answer would be I would need to-I would have to know more about a case situation than to say arbitrarily, "You can only come here three times." I think we clearly have to understand in some of the instances what we are talking about these young people getting contraception. The alternative in not getting contraception is pregnancy, and many of the issues are certainly not resolved by a young person becoming pregnant in a situation like that or being faced with the alternative we heard about earlier, which is an abortion.

So I think when we are giving contraceptive services, we generally are talking about a young person, for the most instances, who is not at the ages that you are talking about but who is an older young person. As the high school studies show, that 50 percent or more of young people have had some sort of sexual encounter, and so you are really not doing-giving a drug or not giving a drug based on there being no alternative or no other risk that presents itself.

So I think when you manage young people you look at what the risks are for the total situation in terms of what is being done. And very often for the young people that come to title X the alternative is, "Well, if I can't get contraception, I am not going to have sex anymore." That generally is not what the interpretation is. And very often these young people end up in a situation where they either acquire an STD or they become pregnant unintentionally. So I think we are working in a battleground situation that is not as cut and dry as you want to present it in the situation, let me tell you. They are very complicated, and very often you make decisions in the context of the total picture for the young person, but you appropriately engage agencies when it presents to you a situation that requires that.

Mr. BILIRAKIS. Thank you, Doctor. Mr. Strickland.

Mr. STRICKLAND. Thank you. I am sitting here thinking of a school librarian in my district that was called to the gymnasium of one of my local schools. The girl was sick, the coach said, "See what you can find out." They went into this broom closet. The librarian said to this young girl, "Could you be pregnant?" She said, “Oh, no, I have never done it." And then she started screaming, “It is coming out," and this librarian said, "I pulled down her blue jeans and a baby was born in that broom closet." That is the situation that we face. Then the girl started saying, "My mother will kill me. My mother will kill me." I wish every family in this country was an Ozzy and Harriet kind of family. It is not.

Now, I just want to make something clear. Title X requires that providers comply with State laws on reporting incest, rape and molestation. Is that not true? Can someone answer that?

Ms. JENKINS. Yes.

Mr. STRICKLAND. So what are we talking about? If a 12-year-old comes into your clinic and is pregnant, that child has been molested, the report is made to the authorities, is it not?

Ms. JENKINS. Should be, yes.

Mr. STRICKLAND. Absolutely. I think we ought to clear that up, because I think there has been an implication here that these clinics cover up crime, and I don't think there is any evidence that that is in fact the case.

Dr. Jenkins, just for the record, I want to make sure that from your point of view this is the bottom line. In your professional opinion, H.R. 4783, the Brady Consental Parent Bill, do you believe that bill, if passed in its present form, would be bad for the health of children?

Ms. JENKINS. Yes, I do. I think it would be bad for the health of adolescents who need or who will not be able to access care and prescriptions that would be relevant to their care, yes.

Mr. STRICKLAND. Okay. And a question to Ms.-and if I am mispronouncing the name, I apologize is it Wuchner?

Ms. WUCHNER. That is correct. Thank you.

Mr. STRICKLAND. Ms. Wuchner, do you believe that women who use birth control pills are committing abortion or abortions result from the use of birth control pills?

Ms. WUCHNER. Well, first of all, the question is irrelevant, because we are talking about minor children and medications given to minor children.

Mr. STRICKLAND. But I would like to know your opinion about an adult woman who uses a birth control pill. Do you believe

Ms. WUCHNER. Do I believe she is committing an abortion?
Mr. STRICKLAND. Yes.

Ms. WUCHNER. No. I think the pill operates by three mechanisms and that is scientific fact. Do I believe she is committing an abortion? No, at this point. Do you understand what I mean by that? The pill has three mechanisms of action, which is listed in the PDR. One is to prevent ovulation, the other is to affect the viscosity of the mucous and the other would prevent egg implantation which is a fertilized embryo if that should occur from implanting. It would render the lining unacceptable to that. But we are talking about minor children and prescriptions being given to minor children and treatment being given to minor children without their parents' knowledge, parents who are entrusted to care for these children by just the human nature

Mr. STRICKLAND. I understand.

Ms. WUCHNER. [continuing] puts children in the care of their parent.

Mr. STRICKLAND. And I am sympathetic. I think in nearly all cases certainly parents ought to be involved. What would you say to those circumstances, and they occur and the occur much more frequently than most of us would like to admit, where there is a father, an uncle, some other relative, do you believe there should at least some provision for not involving the parents when a child may have been subjected to an abusive situation within the home itself?

Ms. WUCHNER. The law at that point provides a provision, and that is the requirement that that would be reportable. That is a reportable case to the authorities. It takes it out now of the context of parental consent and now puts it into a legal or an illegal situation that has occurred with a minor child.

Mr. STRICKLAND. But isn't it

Ms. WUCHNER. You see what I am saying, that is separate.
Mr. STRICKLAND. But isn't-

Ms. WUCHNER. And that is not calling the parents to report them if they are the perpetrators of the child. Whoever perpetrates the child that needs to be reported. That is problematic. We are talking about medical care and treatment of minors, and that is different. We are not talking about an abusive situation. It could be an abusive situation, which means that it is reportable.

Mr. STRICKLAND. When a young child is being sexually involved, that is an abusive situation.

Ms. WUCHNER. That is correct. When she is being sexually abused by someone in the family, the authorities are reported and an investigation ensues which would mean parental notification. And if that parent is violating or a member of that family or community is violating that child, then the legal action and the appropriate action is going to take place whether there is going to be natural notification.

Mr. STRICKLAND. Could I just follow up very quickly?

Mr. BILIRAKIS. Very quickly.

Mr. STRICKLAND. Would you be satisfied if the law required under circumstances that are difficult like this that the authorities be notified rather than the parents?

Ms. WUCHNER. The law does require under the circumstances that authorities be notified.

Mr. STRICKLAND. But are the parents also required to be involved under those circumstances, as the law is written?

Ms. WUCHNER. Now, we are talking about circumstances, and we are talking about general medical care that does not involve parents. Under the law, the authorities are notified and parents would immediately become involved because what would take place is the authorities would then go to begin an investigation. See that is a separate issue. We are talking about a child that has been now violated in some range. So that means that there would have been authority notified, and then what happens is it is not the clinician who is treating the child that has notified the parents, because, again, as Mr. Pitts mentioned, adolescents must be assured of their confidentiality, and the musts that are mentioned or the guidelines in title X, those musts are mandatory. You can't breach from those. So the only way around that must is to go to the legal authorities and report it. The clinicians' hands are tied.

Mr. STRICKLAND. My time is up. Thank you.

Mr. BILIRAKIS. Mr. Towns, to inquire.

Mr. Towns. Thank you very much, Mr. Chairman. Let me begin, Mr. Heisler, by making sure that I understood you. You said that the majority-are you saying the majority of the health care professionals support your position or are you saying the majority of the people in McHenry County support your position?

Mr. HEISLER. No, I said the majority of the people in McHenry County.

Mr. Towns. Well, is it true then that before McHenry County Health Board was able to successfully reject title X funding, they first voted not to reject title X funds? Is that true? Yes or no.

Mr. HEISLER. The board itself, the health board itself, we had several votes. It came down to a 4 to 4 at the health department

Mr. TOWNS. Four to 4 is not a majority.

Mr. HEISLER. No, I know. The health board did not initially reject title X. The county board rejected the title X funding. The county board appoints the health board and approves their budget. Mr. TOWNS. Let me make certain I understand. There is a representative by the name of Cal Skinner who changed the numbers on the board in order to break a tie, and then you went out shopping for someone who committed themselves, and indicated the fact that they would vote to reject the funds. You had to campaign to get somebody to do that.

Mr. HEISLER. No, that is not right.

Mr. Towns. After you got that person to do that

Mr. HEISLER. Not at all.

Mr. TOWNS. [continuing] then you ended up having a 5 to 4 vote. Now, how do you arrive at this great majority that you keep talking about here?

Mr. HEISLER. You are misinformed, Congressman. That is not at all what happened. The change in the number of members in the board of health, which is a subboard of the county board, went from five to four, eight to nine, so we could have that 5 to 4 well after this whole title X thing was over with. We didn't want to have that happen again.

Mr. Towns. If it was 4 to 4, how did you get that? I mean somewhere in here I am losing a step.

Mr. HEISLER. Well, let me explain it. The board of health

Mr. TOWNS. Four to 4 is a tie.

Mr. HEISLER. Four to 4 it fails, you are right. Four to 4 it fails. The board of health did not reject it. The county board removed the funding, removed the title X funding. The county board funds the board of health activities.

Mr. Towns. Well, let me ask you this then, isn't it true that the majority of the health care professionals in McHenry County spoke out adamantly in favor of continuing title X funding?

Mr. HEISLER. I wouldn't say that that is true at all.

Mr. Towns. Well, I have a letter from 23 doctors and nurses in McHenry County, as well as a number of organizations, such as the Illinois Caucus of Adolescence Health, who disagree with your opinion on this issue. Isn't it also true that only one physician came out in support of ending title X funding?

Mr. HEISLER. You seem to have the statistics there, sir. I don't know who that one physician might be. I can tell you

Mr. TOWNS. I don't want to meet him either. I don't want to meet him. Go ahead.

Mr. HEISLER. I can only tell you what happened. And what happened, McHenry County appoints the board of health. The county board appoints the board of health. The county board created the board of health. The board of health, through some decision that it might make that perhaps adverse to the philosophy of the elected officials of McHenry County, can in fact dissolve the board of health. The ultimate authority at McHenry County relative to