Accidental disclosure. Health care providers also should make sure that office procedures do not unnecessarily or accidentally disclose information about patients. For example, routinely gathering information about insurance coverage may well trigger the release of information to the policy holder (often a parent). Thus, there should be clear understandings about billing, insurance, and related issues before information is divulged by the patient. This should be part of the process of obtaining informed consent to treatment. It should be up front and honest. Developing a clear understanding of the legal requirements of the state is essential, so that assurance of confidentiality is on legal, solid ground.
Additional resources and guidance
As the pediatric and adolescent segment of gynecologic care continues to evolve, it is noteworthy that the American Board of Obstetrics and Gynecology recently has established a "Focused Practice" designation in pediatric adolescent gynecology. This allows ObGyns to have an ongoing level of professional education in this specialized area. Additional information can be obtained at www.abog.org or info@abog.org.
More resources for adolescent contraceptive care include:
- The American College of Obstetricians and Gynecologists (ACOG) "Birth Control (Especially for Teens)" frequently asked questions information series (https://www.acog.org/Patients/FAQs/Birth-Control-Especially-for-Teens)
- ACOG's Adolescent Healthcare Committee Opinions address adolescent pregnancy, contraception, and sexual activity (https://www.acog.org/-/media/List-of-Titles/COListOfTitles.pdf)
- ACOG statement on teen pregnancy and contraception, April 7, 2015 (https://www.acog.org/About-ACOG/News-Room/Statements/2015/ACOG-Statement-on-Teen-Pregnancy-and-Contraception?IsMobileSet=false)
- North American Society for Pediatric and Adolescent Gynecology resources for patients (https://www.naspag.org/page/patienttools)
- Society for Adolescent Health and Medicine statement regarding contraceptive access policies (https://www.adolescenthealth.org)
- The Guttmacher Institute's overview of state laws relevant to minor consent, as of January 1, 2019 (https://www.guttmacher.org/state-policy/explore/overview-minors-consent-law). It is updated frequently.
Abuse reporting obligations
All states have mandatory child abuse reporting laws. These laws require medical professionals (and others) to report known, and often suspected, abuse of children. Abuse includes physical, sexual, or emotional, and generally also includes neglect that is harming a child. When there is apparent sexual or physical abuse, the health care provider is obligated to report it to designated state authorities, generally child protective services. Reporting laws vary from state to state based on the relationship between the suspected abuser and the minor, the nature of the harm, and how strong the suspicion of abuse needs to be. The failure to make required reports is a crime in most states and also may result in civil liability or licensure discipline. Criminal charges seldom result from the failure to report, but in some cases the failure to report may have serious consequences for the professional.
An ObGyn example of the complexity of reporting laws, and variation from state to state, is in the area of “statutory rape” reporting. Those state laws, which define serious criminal offenses, set out the age below which an individual is not legally capable of consenting to sexual activity. It varies among states, but may be an absolute age of consent, the age differential between the parties, or some combination of age and age differential.21 The question of reporting is further complicated by the issue of when statutory rape must be reported—for example, the circumstances when the harm to the underage person is sufficient to require reporting.22
Laws are complex, as is practice navigation
It is apparent that navigating these issues makes it essential for an ObGyn practice to have clear policies and practices regarding reporting, yet the overall complexity is also why it is so difficult to develop those policies in the first place. Of course, they must be tailored to the state in which the practice resides. Once again, the need is clear for health care professionals to have an ongoing relationship with a health attorney who can help navigate ongoing questions.