CAFP Opposes Proposition 85
As reported in the August 15 edition of AiA, CAFP is opposing Proposition 85, “Waiting Period and Parential Notification Before Termination of Minor’s Pregnancy,” in concert with policy adopted by the Congress of Delegates in 2000. CAFP opposed a similar proposition in November of 2005. According to HealthVote.org, “physicians would have to report details of every abortion they perform on a minor to the state Department of Health Services, and the agency would have to compile the statistics anonymously and publish an annual report. Doctors who fail to notify the parents or guardian could be sued for damages. At any time before a ruling by a judge, the parents or guardian could opt for a settlement payment of $10,000 plus attorney fees from the physician instead of receiving damages."

Current CAFP policy, based on policy adopted by the AAFP and the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and others, is as follows:

Minors and Confidentiality: Minors have the right of confidentiality in the areas of contraception, pregnancy, STDs, and physical and/or sexual abuse in accordance with the following AAFP policy statement and the Joint Statement of the AAFP, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, the Organization for Obstetric, Gynecologic and Neonatal Nurses, and the National Medical Association. A-6-00, 2/00 CoD

“One must attempt to achieve a balance between the rights of the parents and what is necessary to maintain and promote the health and well-being of the adolescent. It is proper and ethical for the family physician to protect an adolescent’s confidentiality. Withholding information from third parties, including parents, may be appropriate when it pertains to but is not limited to contraception, pregnancy, sexually transmitted diseases and physical and/or sexual abuse by a parent. Parental involvement, consent, or notification should not be a barrier to care for the adolescent.” (Paragraph 55 of the report of the Commission on Special Issues and Clinical Interests — “Adolescent Health Care –– Confidentiality” Adopted 1994:243-244;347.)

“Adolescents tend to under-utilize existing health care resources. The issue of confidentiality has been identified, by both providers and young people themselves, as a significant access barrier to health care.

Adolescents in the United States, while generally considered healthy, have a range of problems, including some of such severity as to jeopardize their development and health, their future opportunities, and even their lives. To illustrate, there is an urgent need to reduce the incidence of adolescent suicide, substance abuse, and sexually transmitted diseases and unintended pregnancy.

As the primary providers of health care to adolescents, we urge the following principles for the guidance of our professional members and for broad consideration in the development of policy:

1. Health professionals have an ethical obligation to provide the best possible care and counseling to respond to the needs of their adolescent patients.

2. This obligation includes every reasonable effort to encourage the adolescent to involve parents, whose support can, in many circumstances, increase the potential for dealing with the adolescent’s problems on a continuing basis.

3. Parents are frequently in a patient relationship with the same providers as their children or have been exercising decision-making responsibility for their children with these providers. At the time providers establish an independent relationship with adolescents as patients, the providers should make this new relationship clear to parents and adolescents with regard to the following elements:

a) The adolescent will have an opportunity for examination and counseling apart from parents, and the same confidentiality will be preserved between the adolescent patient and the provider as between the parent/adult and the provider.

b) The adolescent must understand under what circumstances (e.g., life-threatening emergency) the provider will abrogate this confidentiality.

c) Parents should be encouraged to work out means to facilitate communication regarding appointments, payment, or other matters consistent with the understanding reached about confidentiality and parental support in this transitional period when the adolescent is moving toward self-responsibility for health care.

4. Providers, parents, and adolescents need to be aware of the nature and effect of laws and regulations in their jurisdictions that introduce further constraints on these relationships. Some of these laws and regulations are unduly restrictive and in need of revision as a matter of public policy. Ultimately, the health risks to the adolescents are so impelling that legal barriers and deference to parental involvement should not stand in the way of needed health care.” A-6-00, 2/00 CoD

CAFP Endorses Tobacco Tax Initiative
While agreeing the Tobacco Tax Initiative is not perfect, CAFP’s Board of Directors voted to endorse the ballot measure because, in addition to improving ER specialty backup, it provides funding for loan repayment of medical students and recent graduates who serve in medically underserved areas of California. The Steven M. Thompson Physician Corps Loan Repayment Program which emulates the CAFP-sponsored Health Education and Academic Loan Act, will make it easier for those medical students who wish to pursue carriers in family practice medicine to do so without overburdening debt. The Tobacco Tax Act of 2006 accomplishes this by adding an additional 7 1/2 cent tax on each cigarette distributed ($1.50 per pack) and increasing new state cigarette tax revenues by about $1.4 billion annually. These revenues would be allocated to private hospital and physician emergency services, indigent health care, breast cancer research, tobacco use prevention, tobacco smuggling prevention, and nursing education. One lesser known allocation would be to the Steven M. Thomson Physician Corps Loan Program. The allocation would be .75 percent of the Health Treatment and Services Account which is 52.75 percent of the whole or, roughly, $5.5 million per year (though some estimates place this figure much higher). Learn more about the Loan Program here.