An Open Letter to the NC General Assembly: Stop HB 693

Guest columnist Julie Nielsen Lindsey, M.D., responds to NC House Bill 693, which would require notarized parental consent for teens who seek a doctor's care for testing, prevention, or treatment related to STDs, pregnancy, mental illness, and substance abuse.

Dr. Lindsey practices family 
medicine at Cary Healthcare 
Associates in Cary, NC.

As family medicine physician who works with teenagers and as a parent of preteens,  I reject the notion that HB 693 would improve communication in families. Rather, HB 693 would undermine the helpful relationship teenagers have with their physicians and expose teens to increased health risks and pregnancy. HB 693 will also adversely affect physicians who work with teens and fundamentally undermine the therapeutic relationship between teenagers and their medical providers.

As a physician to teens, I strive to be an objective, non-judgmental, caring adult resource whom teenagers can consult about very personal health care needs, including sexual health and mental health. I can assure you that neither I nor any medical colleague I know advocates teen sexual activity, however offering confidentiality opens the door for teens to address sexual and mental health concerns. While we encourage teens to discuss all health matters with their parents including sexual health, we know that sexuality is a difficult topic for teens to discuss with parents, even supportive parents. I am most concerned with how this bill will harm teens in troubled homes. How will HB 693 affect the girl who is raped by her father or her mother’s boyfriend and becomes pregnant or contracts an STD? How will HB 693 affect teens who are depressed and having PTSD due to emotional abuse and neglect by a parent with substance abuse? These are not rare exceptions. Sadly, we see these troubling situations all too often in healthcare settings. If HB 693 passes, teenagers in both supportive homes and troubled homes will be less likely to seek medical care for sexual and mental health care needs, and as a result more teenagers will get pregnant, get STDs, spread STDs, have severe pelvic infections, and there will be more suicides and untreated mental health conditions. 

 In addition to harming teenagers, HB 693 will intrude on physicians’ clinical judgment and professional ethics. Ever since medical school, physicians have been taught to respect teens’ confidentiality in regards to sexual health and mental health, as these are sensitive personal issues fraught with challenges for teenagers. HB 693 would impose a fundamental change in how medicine is practiced, without a full understanding of the harms and without endorsement of the medical community. Such a fundamental change in medical care should originate within the medical community after careful research on benefits and harms.

Furthermore, HB 693 will increase legal liability and confusion for physicians who work with teens. If HB 693 passes, I will not be able to offer my teenage patients STD testing, prescribe birth control or conduct mental health evaluations without first consulting a parent. If it is my clinical judgment that these are needed services and a teen won’t discuss this with their parent, I will either incur liability for offering the service or I will neglect my medical duty by denying the teen the service. To add confusion, HB 693 will not apply to facilities which receive Federal Title X funding or to patients with Medicaid. So before addressing a teen’s concerns, a physician will need to verify what kind of insurance a teen has, and then alter what medical services are offered. There seems to be an element of discrimination, as some teens will be offered more rights and services than other teens, simply based bureaucratic concerns.

Since I work in a private practice, with mostly commercially insured patients, I will be unduly limited in the scope of care that I can offer teenagers compared to what is offered in a federally funded clinic or hospital system. Simply put, teenagers would not have the right to confidential healthcare in my practice, and they will go elsewhere. This will be a boon for facilities that receive Federal Funds. Teens are smart, and they will preferentially seek out health care where they are afforded the confidentiality they need.

 As a family physician, I love working with families, and I cherish the opportunities I have to improve communication between teens and parents. I try to walk that fine line between encouraging teens to delay the onset of sexual activity but still educating them about sexual health, and I always encourage teens to talk with their parents. Typically, parents choose a health care provider whom they trust, and that doctor is an extension of the support the parent offers the teen. There is no adversarial relationship between physicians’ and parents as some proponents of this bill suggest. Rather physicians, parents, and teens typically collaborate in a helpful way. HB 693 would undermine the positive relationship that teenagers have with the family’s health care provider, and teens will get delayed and fragmented care in settings more removed from their family.  

Lastly, I speak as a parent of preteens. Like many parents, I too am uncomfortable by the thought of teenagers having sex, and I am distressed by the highly sexualized and violent content that my children get exposed to through the media and at school. While we as parents prepare our kids the best we can and instill good values, we know that much of our teenagers’ lives are beyond our control. We can hope and pray that our children make good healthy choices, but as they get older we must let go and support rather than control. Offering a teen a confidential relationship with a healthcare provider is a loving way to extend a positive influence in areas where our parental influence is waning. As my children get older, I will take great comfort in leaving the exam room, knowing that my child can freely share any health concern. It is a risky world out there, and all the more teens need access to quality and confidential health care to support them through this challenging time of life and manage the risks. Please, let’s not make life any more difficult for teenagers or for the doctors who serve them. House Bill 693 fundamentally undermines healthcare for teens in North Carolina.

Take action to stop HB 963. Email NC Speaker of the House Thom  Tillis.