BILL ANALYSIS Ó
SENATE JUDICIARY COMMITTEE
Senator Noreen Evans, Chair
2011-2012 Regular Session
AB 499 (Atkins)
As Introduced
Hearing Date: June 14, 2011
Fiscal: No
Urgency: No
EDO
SUBJECT
Minors: Medical Care: Consent
DESCRIPTION
Existing law authorizes a minor, who is 12 years of age or
older, to consent to medical care related to the diagnosis or
treatment of a sexually transmitted disease. This bill would
additionally authorize a minor, who is 12 years of age or older,
to consent to medical care related to the prevention of a
sexually transmitted disease.
BACKGROUND
While the age of majority in California is 18 years old, there
are several statutes allowing minors to consent to various
services without the authorization of their parents and without
disaffirmance upon reaching the majority age.
Specifically, California has for years provided that minors, 12
years of age and older, may consent to medical care related to
the diagnosis or treatment of an infectious, contagious, or
communicable disease if it is related to a sexually transmitted
disease. Parents of a minor who has consented to the specified
medical care under this section are not liable for payment of
the services rendered. State law also authorizes a minor to
consent to the prevention and treatment of pregnancy.
Last year, SB 543 (Leno, Chapter 503, Statutes of 2010)
authorized a minor, who is 12 years of age or older, to consent
to mental health treatment or counseling on an outpatient basis
or to residential shelter services, if specified conditions are
(more)
AB 499 (Atkins)
Page 2 of ?
met.
This bill, co-sponsored by the California STD Controllers
Association, American Congress of Obstetricians and
Gynecologists, District IX and the Health Officers Association
of California, would additionally authorize a minor, age 12 and
older, to consent to medical care for the prevention of a
sexually transmitted disease.
CHANGES TO EXISTING LAW
Existing law provides that a minor who is 12 years of age or
older who might have come into contact with a contagious,
infectious, or communicable disease may consent to medical care
related to the diagnosis or treatment of that disease if the
disease or condition is one that is required by law to be
reported to the local health officer, or is a sexually
transmitted disease as determined by the State Director of
Health Services. (Fam. Code Sec. 6926 (a).)
Existing law provides that the parents of a minor who has
consented to medical treatment for a communicable or sexually
transmitted disease are not liable for payment for that care.
(Fam. Code Sec. 6926 (b).)
Existing law provides that a minor may consent to medical care
related to the prevention or treatment of pregnancy. (Fam. Code
Sec. 6925 (a).)
Existing law provides that a minor's consent under minor consent
statutes cannot be subject to disaffirmance because of minority.
(Fam. Code Sec. 6921.)
Existing law provides that a minor who is 12 years old or older
who is alleged to have been raped may consent to diagnosis and
treatment of that condition. (Fam. Code Sec. 6927.)
Existing law allows a minor alleged to have been sexually
assaulted to consent to medical care related to the diagnosis
and treatment of that condition. (Fam. Code Sec. 6928 (b).)
Existing law allows a minor to consent to medical care related
to the diagnosis or treatment of a drug or alcohol-related
problem. (Fam. Code Sec. 6929 (b).)
Existing law provides that a minor may consent to medical or
AB 499 (Atkins)
Page 3 of ?
dental care if that minor is over the age of 15, living separate
and apart from his or her parents whether with or without his or
her parents' consent, and managing his or her own financial
affairs. (Fam. Code Sec. 6922 (c).)
This bill would authorize a minor, who is 12 years of age or
older, to consent to medical care related to the prevention of a
sexually transmitted disease.
COMMENT
1. Stated need for the bill
The author writes:
There is a gap in the law relative to prevention of sexually
transmitted diseases (STDs). Existing law only specifies the
ability to consent to diagnosis and treatment. This omission
creates a barrier to time-critical preventive services. At
the time the law was passed, the preventive options we have
today did not exist.
We now have time-critical prevention services for sexually
transmitted diseases. Examples include the hepatitis B
vaccines, prophylactic post-exposure HIV medications (which
must be given within 72 hours of exposure) and HPV vaccine
which, if given before exposure, can significantly reduce the
risk of certain cancers and abnormal, precancerous cervical
cell changes and genital warts. In addition to these diseases
being sexually transmitted, they also have in common that they
can be life-long and are only treatable, not curable. The
treatments can be costly in both financial terms and quality
of life.
These services are . . . time-sensitive, and there are
long-term health implications if there is a failure to obtain
the services. All of these therapies need to be provided in a
timely fashion to prevent significant harm. Some adolescents,
AB 499 (Atkins)
Page 4 of ?
from difficult family situations, will either delay or simply
fail to obtain services if confronted with a legal requirement
of parental consent.
The co-sponsor of the bill, the Executive Committee of the
California STD Controllers Association writes, "While most teens
involve their parents in medical decisions, even those involving
sensitive subjects, we need to allow for those minors who can't
or won't include their parents. The current requirement that
minors obtain parental consent for STD prevention services has
resulted in missed and denied opportunities for minors to
receive vital and time-sensitive medical care. The need to
provide prevention services to this population is essential."
The Health Officers Association of California, the co-sponsor of
this bill states, "Prevention of communicable disease is a
primary goal of public health. Prevention allows physicians to
stop diseases before they start, avoiding unnecessary pain,
disability, and medical costs. Preventive measures for STDs
include counseling, age-appropriate education, distribution of
prophylaxis, and vaccination against Hepatitis B and HPV.
Prevention is a vital part of comprehensive care. Provision of
confidential prevention services will help California's
physicians protect the health of our young people."
Also co-sponsoring the bill, the American Congress of
Obstetricians and Gynecologists, District IX (ACOG-IX) writes:
The reality is that teens have the highest rate of sexual
violence, with 1 in 6 women and 1 in 33 men reporting sexual
assault in their lifetimes. Among victims of Ýsexual]
violence, the highest rate exists for those 25 years of age
and below. Thus, teens are at particular risk. What is of
utmost concern to ACOG-IX is teen health and safety. Previous
legislatures, in passing current minor consent laws, have also
taken this position. ACOG policy is to encourage minors to
include their parents in medical decisions. However for some
teens, good family communication is not possible and actually
may be dangerous. The California Supreme Court in a 1997
opinion concluded that forcing parent communication about
sensitive health care can actually endanger teens physically
and emotionally and "exacerbate the instability and
dysfunctional nature of the family relationship."
2. Precedent in the law allowing minors to access medical
services without parental consent
AB 499 (Atkins)
Page 5 of ?
This bill would authorize a minor, 12 years of age or older, to
consent to medical care for the prevention of a sexually
transmitted disease. Under current law minors are allowed to
seek certain services without the consent of their parents or
guardians. For example, a minor may consent to medical care for
the prevention or treatment of a pregnancy (Fam. Code Sec.
6925); medical care relating to rape or sexual assault (Fam.
Code Secs. 6927-6928); medical care and counseling relating to
the treatment of a drug or alcohol related problem (Fam. Code
Sec. 6929); and, as it specifically relates to this bill,
treatment of communicable diseases if related to a sexually
transmitted disease (STD) (Fam. Code Sec. 6926). Thus, there is
precedent in the law which makes exceptions to the general
requirement that minors must have parental consent when
receiving certain medical treatment or counseling. These
exceptions have generally been made when there is a compelling
public policy rationale for making services and treatments more
accessible to minors, and where the requirement of parental
consent would deter minors from otherwise seeking these
services.
This bill, relying on the precedent in current law, would allow
minors, 12 years of age or older, to consent to medical care
related to the prevention of an STD in addition to existing law
which permits minors to consent to the actual treatment of an
STD. Discussing prevention methods of an STD and treatment for
an STD can be particularly sensitive subject matters for minors
to discuss with their parents. While most minors may discuss
other medical care with their parents, there are many who either
cannot have these particular discussions, or simply will not
discuss the possibility of contracting an STD with their
parents. As with the other minor consent laws, the public
policy of preventing the spread of sexually transmitted diseases
arguably outweighs requiring minors to consult with their
parents for these prevention methods.
3. This bill would authorize a minor to consent to medical care
for prevention of a sexually transmitted disease
Under existing law, a minor who is 12 years of age or older, may
consent to medical care for the diagnosis and treatment of an
STD. This bill would additionally authorize a minor, who is 12
AB 499 (Atkins)
Page 6 of ?
years of age or older to consent to medical care relating to the
prevention of an STD.
This bill fills a gap between allowing minors to consent to
medical care for the diagnosis and treatment of an STD and
preventing the STD in the first place. Writing in support of
the bill, Planned Parenthood Affiliates of California notes,
"the gap in the law likely stems from the fact that many
prevention methods did not exist when the law was originally
written in 1964. New developments in STD prevention, such as
vaccinations for hepatitis B and the human papilloma virus
(HPV), as well as prophylactic post-exposure HIV medications
have given rise to the need for this legislation."
a. HPV Vaccine
According to the Centers for Disease Control and Prevention
(CDC), HPV is the most common sexually transmitted disease.
"Approximately 20 million Americans are currently infected
with HPV Ýand] Ýa]nother 6 million people become newly
infected each year. HPV is so common that at least 50% of
sexually active men and women get it at some point in their
lives." In addition to causing genital warts in both men and
women, HPV has also been linked to cervical cancer in women,
and various other cancers in both men and women. Fortunately
there are now ways for people to lower their risk of
contracting HPV. Two vaccines are available for women and one
vaccine is available for men. The CDC states that "both of
the vaccines Ýfor women] are recommended for 11 and 12
year-old girls, and for females 13 through 26 years of age,
who did not get any or all of the shots when they were
younger. These vaccines can also be given to girls as young as
9 years of age." The vaccine for men is available for boys and
men age 9-26 years of age. (See
http://www.cdc.gov/std/HPV/STDFact-HPV.htm .)
b. Hepatitis B Vaccine
The CDC also notes that "national studies have shown that
about 12.5 million Americans have been infected with hepatitis
B virus at some point in their lifetime. One and one quarter
million Americans are estimated to have chronic (long-lasting)
infection, of whom 20 percent to 30 percent acquired their
infection in childhood. Chronic hepatitis B virus infection
increases a person's risk for chronic liver disease,
cirrhosis, and liver cancer. About 5,000 persons will die each
AB 499 (Atkins)
Page 7 of ?
year from hepatitis B-related liver disease resulting in over
$700 million in medical and work loss costs."
However, according to the CDC, "the number of new infections
per year has declined from an average of 450,000 in the 1980s
to about 80,000 in 1999. The greatest decline has occurred
among children and adolescents due to routine hepatitis B
vaccination." (See
http://www.cdc.gov/vaccines/vac-gen/whatifstop.htm#hepb .)
Based on the new prevention methods available for HPV and
Hepatitis B, as well as other sexually transmitted diseases,
it would appear reasonable to allow minors to consent to these
vaccinations in order to prevent these (sometimes deadly)
diseases rather than for minors to contract these diseases
only then to treat them. In support of the bill, the American
Civil Liberties Union writes, "these diseases can be deadly
but they can also be prevented. There are two vaccines that
can prevent the viruses known to cause various types of
cancer, the hepatitis B vaccine and the human papilloma virus
(HPV) vaccine. Both viruses, if not cleared by the body
naturally like a cold virus, are incurable. The infections
can have devastating lifelong implications, including liver
cancer and cancers of the cervix, penis and anus. Recent
reports show HPV cause more oral, head and neck cancers in men
than does tobacco use."
The main focus of HPV prevention has been on young women due
to the connection between HPV and cervical cancer, however, a
recent article reported that studies show that "half of the
general population of men may be infected with human
papillomavirus." As a result, researchers have suggested that
this study strengthens the case for also routinely vaccinating
men for HPV. (See
http://www.reuters.com/article/2011/03/01/us-cancer-vaccine-idU
STRE7200CJ20110301 .)
3. Opposition's concerns:
The California Catholic Conference, Inc., in opposition, argues
that "most parents are involved in the lives of their minor
children and want and need to know if they are seeking medical
care-regardless of whether the care is preventative or curative.
Of course there are occasions when parents do not adequately
care for the welfare of their minor child, but it is certainly
not the usual case." The California Catholic Conference
AB 499 (Atkins)
Page 8 of ?
continues with "this bill is dangerous because it expands a
faulty law which assumes that children know better than their
parents and because it will allow minors access to HPV vaccines
which may cause them permanent harm."
In response to the opposition's concerns, the author writes,
"while physicians encourage their minor patients to involve
parents, the Legislature has recognized by enacting minor
consent laws that involvement is not always practical and what
is paramount is that teens receive timely, necessary medical
care."
Support : ACCESS Women's Health Justice; ACT for Women and
Girls; American Civil Liberties Union; American Association of
University Women; Asian Communities for Reproductive Justice;
California Adolescent Health Committee; California Coalition for
Youth; California Commission on the Status of Women; California
Communities United Institute; California Family Health Council;
California Medical Association; California National Organization
of Women; California Nurses Association; California Primary Care
Association; California School Health Centers Association;
Children's Law Center of Los Angeles; County of Los Angeles
Board of Supervisors; Having Our Say; Kaiser Permanente; Los
Angeles Gay and Lesbian Center; Maternal and Child Health
Access; Mental Health Association in California; National Center
for Youth Law; National Association of Social Workers-California
Chapter; NARAL-Pro-Choice California; National Council of Jewish
Women; Nevada County Citizens for Choice; Planned Parenthood
Affiliates of California; Planned Parenthood Advocacy Project
Los Angeles County; Planned Parenthood Mar Monte; Reproductive
Justice Coalition of Los Angeles; Women's Health Specialists
Opposition : California Catholic Conference; Capitol Resource
Family Impact; Capitol Resource Institute; California Right to
Life Committee
HISTORY
Source : California STD Controllers Association; American
Congress of Obstetricians and Gynecologists, District IX; Health
Officers Association of California
Related Pending Legislation : None Known
Prior Legislation : None Known
AB 499 (Atkins)
Page 9 of ?
Prior Vote :
Assembly Floor (Ayes 50, Noes 25)
Assembly Committee on Judiciary (Ayes 7, Noes 2)
Assembly Committee on Health (Ayes 13, Noes 5)
**************