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a minor and I want this medication.” Can you, according to the law, call that child's parents and tell them what is going on? I am not talking about what you want to do, I am just saying legally could you do that the way the law is set up now?

Ms. JENKINS. Under title X?
Mr. AKIN. Yes.

Ms. JENKINS. What has been discussed here is that apparently to pick up the phone and call the parent at that point would be not allowed under title X.

Mr. AKIN. So it would be illegal for you to do that.

Ms. JENKINS. As far as I understand title X. I don't know if you are trying to set me up.

Mr. AKIN. No. I am just trying to get the facts as to how this works. I am not trying to get you thrown in jail.

Ms. JENKINS. Okay. I don't have it in front of me, but based on what we have talked about, that is what the guidelines say, okay?

Mr. AKIN. Ms. Wuchner, is that your understanding that that would be

Ms. WUCHNER. Yes, Mr. Akin, that is correct. Mr. AKIN. So it would be illegal for people Ms. WUCHNER. I am looking at the regs, exactly. It would be illegal

Mr. AKIN. Okay. So they could not do that.

Ms. WUCHNER. It would be in violation of the guidelines that are mandated in title X, yes.

Mr. AKIN. Okay. Now, Dr. Jenkins, you have mentioned that you deal with a lot of different kinds of situations, and some of them are just kind of dicey; they are not the sort of things that areI understand that. But also there are some families that are functional out there. What this law says to me is that de facto we are giving the minor the right to choose their parents, effectively, in this situation. And they are saying as a minor, “Well, you know, my parents, I don't really want to accept what they are saying is right and wrong or what they think I should be doing, and so I am going to end run their authority and come to you.” Does it make you feel uncomfortable when the parents know nothing about it, let alone consent to it, that in a sense you usurp their role as an agent of the State in cases where maybe there is a very functional family?

Ms. JENKINS. My experience has been that a lot of times young people overestimate the reaction of their parents, okay? And what in my position I very often do is to try to work with them around getting a better communication with their parents about it. I don't just say, “Okay, you don't want to tell your parents. Okay. There is no discussion about that.” Because I have found that over time when there is a functional family that most parents would rather their kids get some help and not be at risk for adverse and negative outcomes. One of my very first experiences of health

Mr. AKIN. Well, I think you answered my question, and actually it seems like a very common sense answer, what you said. You know, what you are saying is is that you try to work with the particular situation, try and bring some reconciliation and maybe steer the child back toward their parents. I mean I think that is a real common sense answer.

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I guess the concern I have is the way the law is set up right now. What you are telling me is that you are prohibited from having the alternative of talking to the parent at all in this situation.

Ms. JENKINS. I don't think that is true. I think what it says-
Mr. AKIN. Unless the kid acquiesces.

Mr. AKIN. So in every one of these situations we are basically giving the government the de facto right to usurp or to take over the role of parents without the parents' knowledge or consent when the child is a minor. That is the way it is set up now. I think most of us believe that, yes, if you can, you work with the parents, but it seems like the law is actually contrary to that situation, and it seems like to me you talk about making decisions, the first natural line of defense for the child is the parents. And who is making the decisions? Doesn't it seem logical to at least give the parents a chance to be parents? I understand there are dysfunctional families, I understand there are parents who don't want to make the decisions, don't care about their children. But there are some who do.

Mr. BILIRAKIS. Well, the gentleman's time has expired. Ms. Capps, for 30 seconds to finish this up.

Ms. CAPPS. I was going to ask my colleague to yield and just to give Dr. Jenkins an opportunity. You are assuming that it is a mechanical situation where a child comes in, demands a prescription and it is automatically written. And I don't think that is the kind of relationship that I heard Dr. Jenkins talking about. The optimum relationship is one where you have known this adolescent over years, if possible. Now, that is not always that way, but there certainly isn't anything in this law, as I understand it, that requires that the State usurps the role of the parent. It does give one protection really for abnormal, abusive relationships in which a child is a victim. And there is no adult other than this provider who is a professional, who should be trusted to both report and also work with. Now, that is why I think it is difficult to answer the question because it is not one that I would assume that you find yourself in.

Mr. BILIRAKIS. Well, the gentlelady's time is long expired. Ms. Wuchner, as long as everybody is taking liberties

Ms. WUCHNER. Yes, sir.

Mr. BILIRAKIS. [continuing] do you feel that there should be more flexibility in title X? I mean, you know, we have discussed all of these problems, and we know that there are all sorts of different and often very difficult situations, and I think it is very easy to put ourselves in the shoes of Dr. Jenkins and some of the patients that she sees. But from the standpoint of flexibility, do you have a comment, very briefly? I don't want to—you know, we have been at this for 242 hours now.

Ms. WUCHNER. Okay. Basically, I think there has been a lot of confusion. It is not the long-term relationship that happens in a public health clinic, it is short term. Usually the patient, there are two visits, and clinicians would love to encourage young people to notify their parents, but that doesn't take place, and I told you in 75 percent of the times it doesn't.

Mr. BILIRAKIS. And they can't do that without the approval of the child; is that right?

Ms. WUCHNER. Without the approval of the child. It is the mandates of title X, they are restricted by that. So there is not an opportunity to bring that child and that parent together in dialog without the permission even when the clinician know it is in the best interest of that child and they are fearful.

Mr. BILIRAKIS. Even if Dr. Jenkins, who seems to
Ms. WUCHNER. In a title X clinic.

Mr. BILIRAKIS. [continuing] I mean not seems to, who cares about children, if Dr. Jenkins feels that she should do it in certain instances, unless she gets the approval of the child, she can't do it.

Ms. WUCHNER. I am a nurse and I have worked with doctors for many years as a nurse, and we use nurses in our clinics because that is what required by the State. And there is not one clinician that wants to come there that day and give bad care, but the law ties the hands of the clinician, it ties the hands of the board. We could not make our decision, and this is the point that we came to where it was an agreement almost on the majority of the board that title X was problematic in this area.

Mr. BILIRAKIS. All right.
Ms. WUCHNER. I hope I answered your question.

I Mr. BILIRAKIS. You did, you did. All right, listen. The record remains open obviously for opening statements on the part of the members of the committee, and also remains open regarding the opportunity to submit questions to you three good people where hopefully you will respond to those in a timely fashion. You know, we appreciate it very much. We can just go on and on and on. This is a very significant topic, obviously. Yes, ma'am?

Ms. ČAPPS. May I just make one question to you, Mr. Chairman. Mr. BILIRAKIS. Lois, very quickly.

Ms. CAPPS. Twenty-five States have laws guaranteeing access to contraception to minors, and 50 States for STD treatment. So this law, if it is enacted by Congress, will usurp a lot of States' rights; am I correct?

Mr. BILIRAKIS. You are telling me, don't ask me. Well, I don't know what the future of this legislation is, but obviously it would have an opportunity for debate in all of these technical points, and the answer to your question would all come out. But these good people are here to help us make those decisions.

Ms. CAPPS. And I just-since Ms. Wuchner has worked in a lot of these clinics, doctors don't have to prescribe. I mean the question that came from my colleague very to the point of saying that the minor comes in and you can't notify the parent. But you also don't have to prescribe.

Ms. WUCHNER. First of all, I will just clarify, I have never worked in the clinic. My area is women's health, but I am on the board of the directors of the health department.

Ms. CAPPS. Well, I guess it would be Dr. Jenkins. I mean you don't automatically write a prescription for a 12-year-old.

Ms. JENKINS. No. There are lots of reasons why you wouldn't do that.

Ms. CAPPS. Where you would not do that, it would not be in the child's best interest.

Ms. JENKINS. Right.
Mr. BILIRAKIS. Okay. All right.
Ms. CAPPS. I promise not to ask anymore.
Mr. BILIRAKIS. The hearing is over. Thank you very much.
[Whereupon, at 5:35 p.m., the subcommittee was adjourned.]
(Additional material submitted for the record follows:]

PREPARED STATEMENT OF McHENRY COUNTY CITIZENS FOR CHOICE McHenry County Citizens for Choice (MCCC) is a local non-partisan grassroots organization dedicated to education about women's reproductive rights. We represent the full spectrum of McHenry County voters. Our activists include a cross section of moderate Republicans and concerned Democrats who are also members of such diverse groups as the League of Women Voters, The Women's Leadership Council, The American Association of University Women, and The Religious Coalition for Reproductive Choice. Supporters also belong to professional groups such as the American Academy of Pediatrics, the American Medical Association, and the American Association of Public Health.

MCCC represents thousands of citizens in McHenry County who have been diametrically opposed to the past and present attempts of Congressman Donald Manzullo (R-16) to deny minors confidential access to the Title X program through the imposition of federal parental consent restrictions.

In McHenry County, during the 1997-1998 period under discussion, there were hundreds of post cards and letters sent to the county board in support of Title X funding. In addition, more than twenty local medical doctors, including pediatricians, signed a common letter of support. None of these documents were ever publicly or privately acknowledged. Other medical professionals, public health administrators, advocates for adolescent health and private citizens wrote letters to the editor of the local paper and came forward at regularly scheduled meetings of the Board of Health and the full County Board to speak in favor of retaining Title X funds and it is noteworthy that the two medical doctors on the Board of Health supported Title X. Congressman Manzullo has continually failed to address the concerns of his constituency regarding this matter in his attempts to make this a national issue.

The major travesty however, was the way in which opponents of Title X repeatedly attempted to link a local criminal case involving predatory sexual abuse with the teen confidentiality requirement in Title X. That action confused the issue and distracted local elected officials whose concern should have been focused on the public health issue under their jurisdiction.

The case in question began in 1997 and involved a multimillion-dollar lawsuit alleging sexual abuse of a minor, which was brought against a teacher, his employerCrystal Lake School District 47, and the County Health Department. In a subsequent civil suit against the local Church of Jesus Christ of Latter Day Saints, the girl divulged that the teacher, who was also a youth minister at the church, originally befriended her during a church outing to Six Flags Great America. According to court records the abuse began in the spring of 1995. Nine months later the abuser took the girl to the Health Department where she told nurses and a doctor that she needed birth control. The records indicate that she had been sexually active for nine months before her visit to the Health Department.

Nevertheless, Congressman Manzullo misrepresented the true situation when he was quoted in an interview with the local newspaper, “It simply brings into focus what happens when a 14-year-old receives birth control shots from a health department without the knowledge or consent of the parents.'

To complicate matters, the law suit brought by the parents of the victim against the County Health Department and the school district effectively curtailed any public discussion at the county level. At one point the County Board was also involved peripherally in the legal entanglement. It provided a large window of opportunity for only one side of the issue to be aired since the litigation forced the Health Department professionals, the Board of Health and eventually the County Board, to remain silent under direction of their attorneys. The hundreds of cards, letters, and petitions signed and submitted by ministers, teachers, healthcare workers and local residents received no response or public recognition.

The local newspaper filled its pages for months with articles about the “sex scandal.” It repeatedly cited the use of Title X services, thereby craftily relaying a subliminal message about the evils of contraceptive availability. There were two other cases of sexual misconduct with minors involving teachers in McHenry County during this same period; one teacher convicted in 1997 and another facing charges that

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same year. However, apparently because contraception was not an issue, both received only a perfunctory reference in the last paragraph of a front page article on this case.

Was there really a concern for the well-being of a teen victim or was it an opportunity to take the focus away from Title X as a public health issue and replace it with personal religious ideology shrouded in the cloak of “parental control?” “Parental control” has long been a wedge issue for ultra-conservatives and to engender fear is an effective tool when in reality your position has no substance. Religious political manipulation can have tragic consequences in the lives of real people especially when it is substituted for sound professional consideration on issues of public health.

Teenage sex is a serious issue with two aspects: (1) moral, and (2) public health. The morality of the issue must be handled by the teenagers, their parents, and their clergy or other professionals they wish to involve. The public health side is appropriately handled by the civic agencies such as the Health Department which is charged with maintaining the health and safety of the citizenry. It is yet another example of the importance of keeping issues properly categorized. It was when the Health Department abandoned its civic mission and became an arbiter of morality due to extreme political pressure that the issue became so muddled that everyone sustained a loss; the teens, the community, the taxpayers and the integrity of our local government.

The ideal concept of parents communicating and guiding their adolescents through the difficult years to adulthood is one on which we can all agree. The problem is, we are not in an ideal world. We are in a world of advertising which sells products by promising better sexual opportunities. A world where there are less than ideal homes, where little or no information is given, where parenting skills are lacking and in some where real abuse exists.

The confidentiality of Title X is no threat to parental involvement. Parents can and should talk to their children and educate them on these issues every day of their lives. With accurate information, open communication and the opportunity to discuss good and bad choices along with consequences and responsibilities ... many of society's problems could be solved.

The concept of parental involvement is right. But laws are not the answer. More realistically, in our community, as in many, we need to build the societal infrastructure to ensure reasonable success for our teen population in navigating the difficult adolescent years. By that we mean comprehensive sexuality education and parenting classes for both parents and teens, a coordinated community effort sponsored by hospitals, schools, churches, local agencies and the media.

What happened in McHenry County was not about parent's rights. It was about closing access to information, professional counseling and reproductive care. It was about changing the focus from all the positive elements of Title X and furthering a child rearing philosophy based on withholding contraceptive information. It was about punishing teens who have disobeyed their parent's by forcing them to bear the consequences of an unwanted pregnancy or sexually transmitted disease to teach them a lesson. It was also about some parents, unsure of their own ability to communicate effectively with their teens, trying to block out any source of information that might be available in the community. Something like burning books.

If there was any doubt that right-wing politics and personal religiosity had a stranglehold on this issue from the beginning, it should be noted that it was the wife of the chairman of the health board who raised the level of rhetoric against Title X (with the backing of a local right-wing state representative). This person organized a demonstration outside the county building before a health board meeting where the only non-print medium represented was a religious television station.

Locking the door of Health Departments by requiring parental consent will not keep teens from having sex. We know that 85% (Planned Parenthood ) are already sexually active for nearly a year before they access those services. When they do, it is because they fear they may be pregnant.

If contraceptive availability is not why teens have sex then what is? Many teens find solace in sexual relationships when love, attention and self esteem are missing in their lives. They want someone who will love them unconditionally and not leave. We fail to acknowledge that teenagers have sex for the same reasons adults do. We lose credibility when we deny that our children are sexual beings. But they must be made aware that having sex carries with it all sorts of responsibilities. They must feel a responsibility for the physical and emotional well-being of the other person and be prepared for all the possibilities and decisions that being sexually active may present to them such as disease and unintended pregnancy. For those reasons and others, it is both desirable and rational to be abstinent until physically, emotionally and financially able to enter a committed long term relationship.

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