TEENAGERS, HEALTH CARE, AND THE LAW - New York Civil ...

TEENAGERS, HEALTH CARE, AND THE LAW:

A Guide To Minors' Rights in New York State

The New York Civil Liberties Union in collaboration with The Lowenstein Center for the Public Interest at Lowenstein Sandler LLP 3rd edition, 2018

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SECTION ACKNOWLEDGMENTS

Teenagers Health Care and the Law was drafted by Catherine Weiss, Elias Kwon, Rachel A. Shapiro,

TITLE Patrick J. Vinett, Mary Knodel, Donna Lieberman,

and Katharine Bodde based on prior editions by Jessica Feierman, Donna Lieberman, Anna Schissel, Rebekah Diller, Jaemin Kim and Yeuh-ru Chu. The authors wish to acknowledge support from Beth Haroules, Erin Beth Harrist, Bobby Hodgson, Rashida Richardson, Abby Allender, Sebastian Krueger, Carrie Chatterson and youth organizers from the NYCLU's Teen Activism Project.

TABLE OF CONTENTS

INTRODUCTION..................................................... 8

I. BASIC DEFINITIONS........................................ 12

Who Is a Minor?............................................................................ 13 Who Is an Adult?.......................................................................... 13 What Is Informed Consent?....................................................... 13 What Is Confidentiality?............................................................ 15

II. CONSENTING TO HEALTH CARE.................. 16

Minors and Consent.....................................................................17 Adults Who Can Consent on Behalf of a Minor.................... 19 Parents.......................................................................................... 19 Guardians and Parental Designees.......................................... 20 The Commissioners of Health or Social Services.................. 20 Consent for Vaccinations............................................................ 21 Legal Status and Minors' Rights to Consent to Care...........22 Married Minors.............................................................................22 Minors Who Are Parents.............................................................22 Pregnant Minors...........................................................................23 Emancipated Minors....................................................................24 Incarcerated Minors....................................................................26 Mature Minors..............................................................................27

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III. CONFIDENTIALITY IN HEALTH CARE...........28

General Confidentiality Rules..................................................29

Schools and Confidentiality......................................................32

When Otherwise Confidential Care May Not Be Confidential........................................................... 35 Child Abuse Reporting............................................................... 36

What Is the Child Abuse Reporting Law?........................... 36 How Might the Reporting Law Present a Confidentiality Problem for Non-Abused Minors?.............37 Sexually Transmitted Infection Reporting............................... 39 Prevention of "Harmful Acts" to Third Parties........................ 39 Court Proceedings...................................................................... 40 Confidentiality Among Health Care Providers and in the Insurance and Billing Process................................ 40

IV. TYPES OF HEALTH CARE THAT MINORS CAN RECEIVE WITHOUT PARENTAL CONSENT.................................... 46

Birth Control.................................................................................47 Consent and Access ...................................................................47 Confidentiality............................................................................. 48 Exception: Sterilization ............................................................. 48

Emergency Contraception........................................................ 49 Purchasing Emergency Contraception..................................... 49 Emergency Contraception, Medicaid, and Title X.................. 49 Emergency Contraception and Rape Crisis Care................... 50

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Consent........................................................................................ 50 Confidentiality............................................................................. 50

Abortion........................................................................................ 50 Consent........................................................................................ 50 Confidentiality.............................................................................. 51

Sexually Transmitted Infections (STIs)...................................52 Consent.........................................................................................52 Confidentiality..............................................................................52

HIV/AIDS....................................................................................... 53 Consent........................................................................................ 53 Testing.......................................................................................... 54 Confidentiality............................................................................. 55 Special Confidentiality Considerations in HIV/AIDS Care......................................................................... 55

Disclosure to a Minor's Parents or Guardians................... 56 Disclosure to a Minor's Adoption or Foster Care Agency, Adoptive or Foster Parents, or Attorney.............. 56 Disclosure Pursuant to Written Consent.............................57 Disclosure Pursuant to a Court Order ................................57 Tests and Diagnoses of HIV: Reports to the Department of Health........................................................... 58 Tests and Diagnoses of HIV: Contact Tracing................... 58 Ongoing HIV Treatment: Partner/Contact Notification .............................................. 60

Prenatal Care, Labor, and Delivery Services.........................62 Consent.........................................................................................62

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Confidentiality..............................................................................62

Sexual Assault Care................................................................... 63 What Is Sexual Assault?............................................................ 63 What Does Sexual Assault Care Involve?................................ 63 Consent........................................................................................ 64 Confidentiality............................................................................. 65

Mental Health Counseling and Services................................67 Consent.........................................................................................67

Outpatient Treatment ............................................................67 Inpatient Treatment............................................................... 69 Confidentiality .............................................................................70

Alcohol and Substance Abuse Services.................................72 Consent......................................................................................... 72 Confidentiality..............................................................................73

Emergency Care...........................................................................75 Consent.........................................................................................75 Confidentiality..............................................................................76

Transgender-Related Health Care...........................................76 Consent.........................................................................................76 Confidentiality.............................................................................. 77 Equal Access to Health Care...................................................... 77 Coverage for Low-Income Minors.............................................. 77

V. MINORS IN FOSTER CARE.............................78

HIV-Related Information............................................................79

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Reproductive Health Care........................................................ 80 Transgender-Related Health Care........................................... 81

VI. PUBLIC HEALTH INSURANCE PROGRAMS AVAILABLE TO MINORS............82

Medicaid....................................................................................... 83 Eligibility....................................................................................... 83 Confidentiality............................................................................. 85 Child Health Plus........................................................................ 86 Eligibility....................................................................................... 86 Confidentiality..............................................................................87

CONCLUSION....................................................... 88

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INTRODUCTION

Adolescents often do not get the health care they need.1 Research over decades has confirmed that one major barrier is adolescents' fear that health care providers will disclose confidential information about sensitive issues to their parents or guardians.2 But in many situations, the law allows teenagers to obtain medical treatment ? including "sensitive" health care, such as reproductive or mental health services ? without their parents' involvement or even knowledge.

This booklet seeks to clarify teenagers' rights under New York State and federal law to make their own medical decisions. It is designed as an aid to teenagers and the professionals ? social workers, counselors, teachers, and medical providers ? who work with young people.

Frequently, professionals can encourage communication between young people and their parents, helping adolescents find needed support as they confront health issues. When teenagers cannot or will not speak to their parents, professionals can encourage them to seek the support of other adults ? family members, friends, social workers ? rather than face their health problems alone. By publicizing information about adolescents' rights, however, we hope to encourage teens to seek medical care even when they cannot or will not confide in adult family members or friends. We also hope to encourage professionals to respect the rights of adolescents and provide care when a minor does not seek adult involvement. After all, health care without adult involvement is generally preferable to no health care.

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