Provides treatment for sexually transmitted diseases to minors without a parent's or guardian's consent

Summary of specific provisions

Section one amends section 2305 of the public health law to provide that no person other than a health care practitioner shall diagnose, treat or prescribe for a person who is infected with a sexually transmissible disease, or who has been exposed to infection with a sexually transmissible disease, or dispense or sell a drug, medicine or remedy for the treatment of such person except on prescription of a health care practitioner.

Amends subdivision 2 of section 2305 of the public health law to provide that a health care practitioner may diagnose, treat or prescribe treatment for a sexually transmissible disease for a person under age eighteen without the consent or knowledge of his or her parents or guardians where such person is infected with a sexually transmissible disease or has been exposed to infection with a sexually transmissible disease.

This section also provides that a health care practitioner may provide health care related to the prevention of a sexually transmissible disease, including administering vaccines, to a person under age eighteen without the consent or knowledge of his or her parents or guardians, without regard to the person's age, provided such person has the capacity to consent to the care and the person consents. The section further provides that any release of patient information regarding vaccines administered under this section shall be consistent with sections 17 and 18 of the public health law and other applicable laws and regulations.

In addition, this section defines "health care practitioner."

Section two provides the effective date.

Justification

Cancers related to the human papillomavirus (HPV) are a serious public health concern and continue to increase. The President's Cancer Panel recently reported the urgent need for action to increase HPV vaccinations.

HPV is the most common sexually transmitted infection (STI) in the US, according to the Centers for Disease Control and Prevention (CDC). HPV is so widespread that 14 million people will become newly infected this year. HPV is spread through skin-to-skin contact during all forms

of sexual interaction, even in the absence of intercourse. While most people who are infected will not develop HPV-related health problems, some types of HPV can cause cancer. Each year, over 17,000 women and over 9,000 men are diagnosed with HPV-related cancers. Nearly all cervical cancers are caused by HPV, which results in 4,000 deaths each year in the U.S.

HPV is also reported to cause over 90 percent of anal cancers, and a significant portion of vaginal, vulvar, and penile cancers (CDC). Misinformation has suggested that HPV causes cancer only in women. However, oropharyngeal cancers (cancers in the throat, tongue, and tonsils) caused by HPV have drastically increased in the past 15 years, with men accounting for over 75% of all oropharyngeal cancer cases.

There are two HPV vaccines that are approved by the U.S. Food and Drug Administration. The CDC has determined that the vaccines are safe, protect people from most of the cancers caused by HPV, and are highly effective (up to 99% effective against precancers). The CDC recommends that males and females receive the HPV vaccine at age 11-12 to be most effective, and catchup vaccinations can be administered through age 26. The HPV vaccines are most effective when administered before a person becomes sexually active and before potential exposure to HPV. In addition, the CDC-recommended age is 1112 because the immune response to the vaccine is higher in preteens than in teens and young adults.

For the vaccine to be most effective, it is administered in a series of three doses. In New York State, only 45% of females aged 13-17 years received all three of the recommended doses of the vaccine, and only 19% of males in the same age range received all three doses in 2013 (CDC).

Currently, section 2305 of the public health law explicitly allows for the testing and treatment of STIs without a parent's or guardian's consent. The law does not specifically allow for the prevention of STIs without a parent's or guardian's consent. It is poor public policy that practitioners can treat and diagnose STIs, but they cannot help prevent an STI that can become fatal. This bill closes this troubling gap in the law.

This legislation makes clear that health care practitioners may provide medical care related to the prevention of a sexually transmissible disease, including administration of the HPV vaccine, to patients under the age of eighteen without requiring a parent's or guardian's consent. This care may only be provided when the patient has the ability to consent to the medical care, and does consent to the care. It is imperative that we promote protection against a preventable fatal disease to those at a time when they will most benefit from that protection.

The Guttmacher Institute reports that the legal ability of minors to consent to a host of health care services has increased substantially over the last 30 years (this includes sexual and reproductive health care, mental health services, and substance abuse treatment). This trend reflects the recognition that, while parental involvement in minors' health care decisions is desirable, many minors will not

access important health services if they are forced to involve their parents.1,2

Scientific research has consistently de-bunked the notion that the HPV vaccine promotes promiscuity and risky sexual behavior. The research consistently shows that the HPV vaccination does not encourage the onset of sexual activity or promote risky sexual behavior (such as an increased number of sexual partners or decreased condom use).3,4.5,6

In addition to preventing human suffering and tragedy, cancer prevention is certainly more cost-effective to the state's health care system than cancer treatment.

Lastly, a broad base of expert health care providers working in the field of adolescent health care and pediatrics support the confidential provision of the HPV vaccine to teens. This includes the New York Chapter of the Society for Adolescent Health and Medicine, the New York State Academy of Pediatrics, District II, Community Healthcare Network, Columbia University Medical Center, Mount Sinai Adolescent Health Center, Family Planning Advocates of New York State, and numerous others.

Fiscal implication

None to the state.

Effective date

Immediately.

1. J.D. Klein et al., Access to medical care for adolescents: Results from the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls, 25 J. of Adolescent Health 120 (1999). 2. D.M. Reddy et al., Effect of Mandatory Parental Notification on Adolescent Girls' Use of Sexual Health Care Services, 288 JAMA 710 (2002). 3.Mayhew, Allison, et al. "Risk Perceptions and Subsequent Sexual Behaviors After HPV Vaccination in Adolescents." Journal of American Academy of Pediatrics 133.3 (2014): 404-411. 4. Rysavy, Mary B., et al. "Human papillomavirus vaccination and sexual behavior in young women." Journal of pediatric and adolescent gynecology 27.2 (2014): 67-71. 5. Hansen, Bo T., et al. "Human papillomavirus (HPV) vaccination and subsequent sexual behaviour: Evidence from a large survey of Nordic women." Vaccine 32.39 (2014): 4945-4953. 6. Liddon, Nicole C., Jami S. Leichliter, and Lauri E. Markowitz. "Human papillomavirus vaccine and sexual behavior among adolescent and young women." American Journal of Preventive Medicine 42.1 (2012): 44-52.