The con of confidentiality

By Joyce Mucci
web posted August 2, 1999

The confidentiality regulation that federally funded family planning clinics enjoy in the United States may cost young adolescent females their reproductive life.

A study published in the Journal of Pediatrics in March 1999 reveal that in the course of one year over 10,296 pap smears were done on a predominately all white population from rural and suburban Maine, New Hampshire and Vermont. The Department of Pathology, University of Vermont, conducted the study and Flecher Allen Health Care in Burlington, Vermont. Flecher Allen Laboratories is under contract with Planned Parenthood to do routine lab work.

Seventy-three percent of the population studied were Pap smears that came from Planned Parenthood. Alarmingly, the clients ranged in age from a mere 10 years old to 19 years. The Pap smear were "diagnoses to determine the prevalence rates of cytomorphologic identifiable entities of both an infectious and precancerous nature in pediatric and adolescent girls." Essentially, the pathologist was looking for conditions that are a precursor to HPV (Human Papilloma Virus). The researchers noted that, "The causal relationship of the sexually transmitted human papilloma virus (HPV) and squamous intraepithelial lesions (SIL) with carcinoma of the cervix has been well described." According to the researchers this is the "largest series evaluating Pap smear diagnoses in this age group in the past decade in the United States."

Among this population diagnosed were 378 cases in the 10 to 14-year-old group, of which there were varying degrees of SIL's ranging from low grade to high grade to undetermined. These diagnoses excluded HPV however; patients who have been diagnosed with HPV have SIL's which leads to life threatening cervical cancer according to the study.

Additionally, these girls also were diagnosed with infections ranging from fungus to herpes. "The 14.6% rate of infectious processes, excluding HPV, was the highest in the 10 to 19-year-old age cluster and when studied in 5-year groupings, showed the highest percentage in 10 to 14-year-old girls (16.7%)" The researches commented that the infections "although not life threatening, many of these microbiologic entities necessitate medical intervention."

From a clinical perspective it is a distressing trend to most health care workers and researchers that they are confronted with sexually transmitted diseases in females so young. This has lead the American Academy of Pediatrics to make "recommendations that pelvic examination and routine Pap smear should be offered as part of preventative health maintenance to patients between 18 and 21-years-of-age." However, there is a distinct difference between and 18-year-old and a 10-year-old.

When Planned Parenthood was contacted regarding these girls they declined to furnish any statistical information. They acknowledged that because of the confidentiality requirement they could not release that information. However, under the plain reading of the Title X Family Planning regulation 42 CFR 59.11 "All information as to personal facts and circumstances obtained by the project staff about individuals receiving services must be held confidential and must not be disclosed without the individual's consent, except as may be necessary to provide services to the patient or as required by law, with appropriate safeguards for confidentiality. Otherwise, information may be disclosed only in summary, statistical, or other form which does not identify particular individuals."

The Alan Guttmacher Institute, who receives grant money from The Department of Health and Human Services (HHS), regularly issues statistical information provided by Planned Parenthood. Information that includes race, income, contraceptive choices, how many times a week a particular population has sex, whether they used a condom and why they sought out reproductive services in the first place. Instead Planned Parenthood directed all inquiries about the population in this study be made to the Vermont Department of Social and Rehabilitative Services who could make available statewide statistics -which of course were not useful about this particular group of girls. The Department of Health and Human Services, Office of Population Affairs spokeswoman Evelyn Kappler indicated that they would be required to look in the legal aspects of the request.

However, there is a larger and infinitely more important issue at hand than mere statistics. When the Pap smears came back to Planned Parenthood for the 10 to 14-year-old group how did the clinic workers explain the results to their young clients? Were parents notified of their children's abnormal test results?

Planned Parenthood, as a rule, does not notify parents, because under Title X regulation the confidentiality of the client is paramount. Unless the youngster requests that a parent is brought into the loop she alone must bear the news that her Pap smear is abnormal and potentially dangerous to her future health and fertility. The Pap smear results, according to Planned Parenthood in Burlington, were reported to the clients by telephone, and counseling about the results was also completed by telephone. An unappealing, cold and distant way to deliver bad news to a child. Considering the mental acumen of most 10 to 14-year-olds it is highly unlikely that they would understand the gravity of the news.

This makes a compelling case for parental notification.

The federal regulation excluding parents or legal guardians from the health care decision making process of minors is based on the flimsy excuse that it would have a chilling effect on a minor seeking reproductive services. Simply because a child resists the intrusion of a parent because of fear or shame is to elevate their reasoning capabilities to that of an adult which flies in the face of common sense. The familial covenant that exists between parent and child should not be usurped because of the statist notion that we know what is best for your children. And the equally bizarre reasoning accepted by federally subsidized family planning providers that 10-year-olds know what is best for them.

The 378 ten to fourteen-year-olds who sought medical services at Planned Parenthood would have been better served if they had been initially evaluated, and the results of an abnormal Pap smear, were discussed in the presence of a parent. Who, by the way, is the only individual who can fully support that child's emotional, physical and spiritual well being. Instead, these youngsters were mere entities on the other end of a telephone line.

Joyce Mucci has been published in the Kansas City Star, MetroVoice and in e-zines such as The New Australian, EtherZone and Rightgrrl where she is an Advisory Board Member.




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