BILL NUMBER:S2712

TITLE OF BILL:  An act to amend the public health law, in relation to
providing medical care to minors for sexually transmitted diseases
without a parent's or guardian's consent

PURPOSE OR GENERAL IDEA OF BILL:

To encourage the prevention of sexually transmitted diseases,
specifically the vaccination against the Human Papillomavirus (HPV) at
a time when it is most effective in order to decrease HPV-related
cancers and fatalities.

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.